Provider Demographics
NPI:1306874946
Name:JARRETT, THOMAS ROY III (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROY
Last Name:JARRETT
Suffix:III
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 1:537 N GREAT NECK RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4035
Mailing Address - Country:US
Mailing Address - Phone:757-463-0193
Mailing Address - Fax:757-463-5338
Practice Address - Street 1:537 N GREAT NECK RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4035
Practice Address - Country:US
Practice Address - Phone:757-463-0193
Practice Address - Fax:757-463-5338
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA250270OtherANTHEM ID #
VAC02660Medicare ID - Type UnspecifiedMEDICARE
VAU63538Medicare UPIN