Provider Demographics
NPI:1093790263
Name:KHALSA, GURUTRANG SINGH (DC)
Entity Type:Individual
Prefix:DR
First Name:GURUTRANG
Middle Name:SINGH
Last Name:KHALSA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1737 WHITEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-2982
Mailing Address - Country:US
Mailing Address - Phone:703-435-1424
Mailing Address - Fax:703-481-9000
Practice Address - Street 1:694 PINE ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4600
Practice Address - Country:US
Practice Address - Phone:703-481-9000
Practice Address - Fax:703-481-9003
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000299111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA228089OtherBLUE CROSS BLUE SHIELD
VA183469Medicare ID - Type UnspecifiedMEDICARE
VAT73332Medicare UPIN