Provider Demographics
NPI:1235300336
Name:PURE N' SIMPLE FAMILY CHIROPRACTIC, INC
Entity type:Organization
Organization Name:PURE N' SIMPLE FAMILY CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHIFFLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:804-435-2273
Mailing Address - Street 1:PO BOX 1355
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-1355
Mailing Address - Country:US
Mailing Address - Phone:804-435-2273
Mailing Address - Fax:804-436-0143
Practice Address - Street 1:56 IRVINGTON ROAD, #1
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-0000
Practice Address - Country:US
Practice Address - Phone:804-435-2273
Practice Address - Fax:804-436-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08286Medicare PIN