Provider Demographics
NPI:1174627509
Name:VINA CHIROPRACTIC CORPORATION
Entity Type:Organization
Organization Name:VINA CHIROPRACTIC CORPORATION
Other - Org Name:VINA CHIROPRACTIC CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-538-8881
Mailing Address - Street 1:6408K SEVEN CORNERS PLACE
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044
Mailing Address - Country:US
Mailing Address - Phone:703-538-8881
Mailing Address - Fax:703-538-8895
Practice Address - Street 1:6408K SEVEN CORNERS PLACE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044
Practice Address - Country:US
Practice Address - Phone:703-538-8881
Practice Address - Fax:703-538-8895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001995111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA461747OtherANTHEM
VAG3800001OtherCAREFIRST
VA490712Medicare ID - Type Unspecified