Provider Demographics
NPI:1194037184
Name:CARECHOICE CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:CARECHOICE CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:SEUNG-WON
Authorized Official - Last Name:BAEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-543-6788
Mailing Address - Street 1:6134 REDWOOD SQUARE CENTER
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2642
Mailing Address - Country:US
Mailing Address - Phone:703-543-6788
Mailing Address - Fax:703-543-4778
Practice Address - Street 1:6134 REDWOOD SQUARE CENTER
Practice Address - Street 2:SUITE 101
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2642
Practice Address - Country:US
Practice Address - Phone:703-543-6788
Practice Address - Fax:703-543-4778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty