Provider Demographics
NPI:1952476244
Name:ACCIDENT AND INJURY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:ACCIDENT AND INJURY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:SHACKELFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-334-5571
Mailing Address - Street 1:ACCIDENT AND INJURY CHIROPRACTIC PC
Mailing Address - Street 2:20385 VIRGIL H GOODE HWY STE 1
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151
Mailing Address - Country:US
Mailing Address - Phone:540-334-5571
Mailing Address - Fax:540-334-5289
Practice Address - Street 1:ACCIDENT AND INJURY CHIROPRACTIC PC
Practice Address - Street 2:20385 VIRGIL H GOODE HWY STE 1
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151
Practice Address - Country:US
Practice Address - Phone:540-334-5571
Practice Address - Fax:540-334-5289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001567111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00W942A01Medicare ID - Type UnspecifiedC09752 GROUP
V60307Medicare UPIN