1669837688 NPI number — CORE CONCEPTS CHIROPRACTIC

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 1669837688 NPI number — CORE CONCEPTS CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORE CONCEPTS CHIROPRACTIC
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:
1669837688
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42882 TRURO PARISH DR
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
BROADLANDS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20148-4456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-723-4178
Provider Business Mailing Address Fax Number:
703-723-5424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42882 TRURO PARISH DR
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
BROADLANDS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20148-4456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-723-4178
Provider Business Practice Location Address Fax Number:
703-723-5424
Provider Enumeration Date:
12/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
POE
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
703-723-4178

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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