Provider Demographics
NPI:1962990531
Name:FOULKS, CHANCELLOR EUGENE (DC)
Entity type:Individual
Prefix:DR
First Name:CHANCELLOR
Middle Name:EUGENE
Last Name:FOULKS
Suffix:
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 1:2150 RUTLAND CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-4456
Mailing Address - Country:US
Mailing Address - Phone:773-322-7993
Mailing Address - Fax:
Practice Address - Street 1:6454 OLD BEULAH ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-3721
Practice Address - Country:US
Practice Address - Phone:703-832-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-28
Last Update Date:2018-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor