Provider Demographics
NPI:1821277369
Name:SPAP HOLDING CORP.
Entity Type:Organization
Organization Name:SPAP HOLDING CORP.
Other - Org Name:KING GEORGE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:DESMOND
Authorized Official - Last Name:PALLOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-775-2250
Mailing Address - Street 1:10244 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-3429
Mailing Address - Country:US
Mailing Address - Phone:540-775-2250
Mailing Address - Fax:540-775-2448
Practice Address - Street 1:10244 KINGS HWY
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-3429
Practice Address - Country:US
Practice Address - Phone:540-775-2250
Practice Address - Fax:540-775-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00V310S74OtherMEDICARE PROVIDER #
VAC08674OtherMEDICARE GROUP #