Provider Demographics
NPI:1073606844
Name:BACK 2 ACTION CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BACK 2 ACTION CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:NUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-425-0048
Mailing Address - Street 1:5294 LYNGATE CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1688
Mailing Address - Country:US
Mailing Address - Phone:703-425-0048
Mailing Address - Fax:703-425-0160
Practice Address - Street 1:5294 LYNGATE CT
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1688
Practice Address - Country:US
Practice Address - Phone:703-425-0048
Practice Address - Fax:703-425-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001409111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC439200Medicare PIN