Provider Demographics
NPI:1336263250
Name:PALLOTTI, SHAWN DESMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:DESMOND
Last Name:PALLOTTI
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 1:9305 KINGS HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-3423
Mailing Address - Country:US
Mailing Address - Phone:540-775-2250
Mailing Address - Fax:540-775-2448
Practice Address - Street 1:9305 KINGS HWY
Practice Address - Street 2:SUITE A
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-3423
Practice Address - Country:US
Practice Address - Phone:540-775-2250
Practice Address - Fax:540-775-2448
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor