Provider Demographics
NPI:1053631127
Name:NATIONAL CHIROPRACTIC CENTER, PLLC
Entity Type:Organization
Organization Name:NATIONAL CHIROPRACTIC CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-787-7722
Mailing Address - Street 1:299 HERNDON PARKWAY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4467
Mailing Address - Country:US
Mailing Address - Phone:703-787-7722
Mailing Address - Fax:703-787-7725
Practice Address - Street 1:299 HERNDON PKWY
Practice Address - Street 2:SUITE 209
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4467
Practice Address - Country:US
Practice Address - Phone:703-787-7722
Practice Address - Fax:703-787-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty