Provider Demographics
NPI:1023023736
Name:GOLDBERG, ILANA PUYING (DC)
Entity Type:Individual
Prefix:DR
First Name:ILANA
Middle Name:PUYING
Last Name:GOLDBERG
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 1:300 N WASHINGTON ST
Mailing Address - Street 2:#102
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3438
Mailing Address - Country:US
Mailing Address - Phone:703-909-4120
Mailing Address - Fax:888-293-4608
Practice Address - Street 1:300 N WASHINGTON ST
Practice Address - Street 2:#102
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3438
Practice Address - Country:US
Practice Address - Phone:703-909-4120
Practice Address - Fax:888-293-4608
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556044111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor