1932269057 NPI number — FAMILY CHIROPRACTIC CENTER OF LAKE RIDGE

Table of content: (NPI 1932269057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932269057 NPI number — FAMILY CHIROPRACTIC CENTER OF LAKE RIDGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY CHIROPRACTIC CENTER OF LAKE RIDGE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932269057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12801 DARBY BROOK CT STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22192-2497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-497-2020
Provider Business Mailing Address Fax Number:
703-492-6105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12801 DARBY BROOK CT STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22192-2497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-497-2020
Provider Business Practice Location Address Fax Number:
703-492-6105
Provider Enumeration Date:
12/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WEINBERG
Authorized Official First Name:
ROSS
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR PRESIDENT
Authorized Official Telephone Number:
703-497-2020

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0104000798 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 215560 . This is a "MDIPA, MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 504133 . This is a "NCPPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1023916 . This is a "AETNA HEALTHCARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 75190 . This is a "NCAS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 231686 . This is a "BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9430604001 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: S398-001 . This is a "CAREFIRST" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".