Provider Demographics
NPI:1093838740
Name:TGVPC
Entity Type:Organization
Organization Name:TGVPC
Other - Org Name:ALTERNATIVE WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-404-1807
Mailing Address - Street 1:2 PIDGEON HILL DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6145
Mailing Address - Country:US
Mailing Address - Phone:703-404-1807
Mailing Address - Fax:703-404-1827
Practice Address - Street 1:2 PIDGEON HILL DR
Practice Address - Street 2:SUITE 280
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6145
Practice Address - Country:US
Practice Address - Phone:703-404-1807
Practice Address - Fax:703-404-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555757111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350001101Medicare ID - Type UnspecifiedNON PARTICIPATING NUMBER
VAC06577Medicare PIN