Provider Demographics
NPI:1871048991
Name:PASSERINI, JUSTIN J (DC, MS, RD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:J
Last Name:PASSERINI
Suffix:
Gender:M
Credentials:DC, MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 342
Mailing Address - Street 2:
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-0342
Mailing Address - Country:US
Mailing Address - Phone:540-992-6637
Mailing Address - Fax:
Practice Address - Street 1:1400 ROANOKE RD
Practice Address - Street 2:
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-2935
Practice Address - Country:US
Practice Address - Phone:540-992-6637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557369111NN1001X, 111NS0005X
GACHIR009634111NS0005X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NN1001XChiropractic ProvidersChiropractorNutrition
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered