Provider Demographics
NPI:1073888921
Name:JM CHIROPRACTIC CLINIC, PLLC
Entity Type:Organization
Organization Name:JM CHIROPRACTIC CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-209-7299
Mailing Address - Street 1:6400 SEVEN CORNERS PL
Mailing Address - Street 2:SUITE F
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2009
Mailing Address - Country:US
Mailing Address - Phone:703-209-7299
Mailing Address - Fax:
Practice Address - Street 1:6400 SEVEN CORNERS PL
Practice Address - Street 2:SUITE F
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2009
Practice Address - Country:US
Practice Address - Phone:703-209-7299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-11
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty