Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 0102202034 | VA |
NPI | 1013334994 |
---|---|
Provider Name | Dr. Shane Chittenden |
First Address | Aldie, VA 20105-3066 |
Second Address | Aldie, VA 20105-3066 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2014 |
Last Update Date | 09/07/2014 |