Provider Demographics
NPI:1023428133
Name:ILLUMINATION, LLC
Entity type:Organization
Organization Name:ILLUMINATION, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYNE
Authorized Official - Middle Name:F
Authorized Official - Last Name:DABU
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM,LAC, DIPLAC
Authorized Official - Phone:757-431-0053
Mailing Address - Street 1:1492 S INDEPENDENCE BLVD.
Mailing Address - Street 2:STE 102
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5252
Mailing Address - Country:US
Mailing Address - Phone:757-431-0053
Mailing Address - Fax:757-431-0053
Practice Address - Street 1:1492 S INDEPENDENCE BLVD.
Practice Address - Street 2:STE 102
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5252
Practice Address - Country:US
Practice Address - Phone:757-431-0053
Practice Address - Fax:757-431-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000588171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty