1336516509 NPI number — HEALING BOUTIQUES CHIROMED INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336516509 NPI number — HEALING BOUTIQUES CHIROMED INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALING BOUTIQUES CHIROMED INC
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:
1336516509
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8408 ARLINGTON BLVD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-4608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-208-7352
Provider Business Mailing Address Fax Number:
703-208-7245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8408 ARLINGTON BLVD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-4608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-208-7352
Provider Business Practice Location Address Fax Number:
703-208-7245
Provider Enumeration Date:
08/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DO
Authorized Official First Name:
THANG
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
703-208-7352

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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