Provider Demographics
NPI:1144211145
Name:COUNTRYSIDE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:COUNTRYSIDE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:ARNDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-444-4141
Mailing Address - Street 1:20 PIDGEON HILL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6154
Mailing Address - Country:US
Mailing Address - Phone:703-444-4141
Mailing Address - Fax:703-444-5407
Practice Address - Street 1:20 PIDGEON HILL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6154
Practice Address - Country:US
Practice Address - Phone:703-444-4141
Practice Address - Fax:703-444-5407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000556111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA105606OtherBCBS
U25933Medicare UPIN
VA350000199Medicare ID - Type Unspecified