Provider Demographics
NPI:1437320629
Name:SHIFFLETT, MATTHEW B (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:B
Last Name:SHIFFLETT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1335
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-1335
Mailing Address - Country:US
Mailing Address - Phone:804-435-2273
Mailing Address - Fax:804-436-0143
Practice Address - Street 1:56 IRVINGTON ROAD
Practice Address - Street 2:#1
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-1335
Practice Address - Country:US
Practice Address - Phone:804-435-2273
Practice Address - Fax:804-436-0143
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104556015OtherSTATE LICENSE