Provider Demographics
NPI:1821157330
Name:FALLWELL, CHRISTINE LEIGH (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:LEIGH
Last Name:FALLWELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 TOTTENHAM LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3153
Mailing Address - Country:US
Mailing Address - Phone:757-498-8700
Mailing Address - Fax:757-498-8764
Practice Address - Street 1:325 FIRST COLONIAL RD STE D
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4665
Practice Address - Country:US
Practice Address - Phone:757-498-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA542014043OtherEIN