Provider Demographics
NPI:1154300069
Name:CHIROPRACTIC HEALING CENTER LTD
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALING CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLABEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-356-6284
Mailing Address - Street 1:8306 C OLD COURTHOUSE ROAD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182
Mailing Address - Country:US
Mailing Address - Phone:703-356-6284
Mailing Address - Fax:703-356-6304
Practice Address - Street 1:8306 C OLD COURTHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182
Practice Address - Country:US
Practice Address - Phone:703-356-6284
Practice Address - Fax:703-356-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-10
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001954111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9403919OtherPHCS
K8660001OtherCAREFIRST BCBS