Provider Demographics
NPI:1336324136
Name:JASSY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:JASSY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JASSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-379-1145
Mailing Address - Street 1:13730 MIDLOTHIAN TPKE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-4317
Mailing Address - Country:US
Mailing Address - Phone:804-379-1145
Mailing Address - Fax:804-379-1174
Practice Address - Street 1:13730 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4317
Practice Address - Country:US
Practice Address - Phone:804-379-1145
Practice Address - Fax:804-379-1174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA111N00000X111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08019Medicare PIN