Provider Demographics
NPI:1700980133
Name:SHEARIN, ELIZABETH TOLLY (DC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TOLLY
Last Name:SHEARIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:TOLLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:111 W VA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2005
Mailing Address - Country:US
Mailing Address - Phone:757-623-7776
Mailing Address - Fax:757-623-1522
Practice Address - Street 1:2469 PRUDEN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434
Practice Address - Country:US
Practice Address - Phone:757-539-4100
Practice Address - Fax:757-539-9187
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T21394Medicare UPIN