Provider Demographics
NPI:1548264104
Name:FODDRELL, GINGER DAVIS (DC)
Entity type:Individual
Prefix:DR
First Name:GINGER
Middle Name:DAVIS
Last Name:FODDRELL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 EARLY SETTLERS RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4458
Mailing Address - Country:US
Mailing Address - Phone:804-330-9830
Mailing Address - Fax:804-421-0869
Practice Address - Street 1:1570 EARLY SETTLERS RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4458
Practice Address - Country:US
Practice Address - Phone:804-330-9830
Practice Address - Fax:804-421-0869
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA119629OtherANTHEM
VAU69914Medicare UPIN