Provider Demographics
NPI:1205036597
Name:RAPHA SPINE & NEURO CENTER-ANNANDALE, INC.
Entity Type:Organization
Organization Name:RAPHA SPINE & NEURO CENTER-ANNANDALE, INC.
Other - Org Name:RAPHA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-444-4030
Mailing Address - Street 1:46161 WESTLAKE DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:POTOMAC FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5871
Mailing Address - Country:US
Mailing Address - Phone:703-444-4030
Mailing Address - Fax:703-444-4142
Practice Address - Street 1:46161 WESTLAKE DR
Practice Address - Street 2:SUITE 330
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-5871
Practice Address - Country:US
Practice Address - Phone:703-444-4030
Practice Address - Fax:703-444-4142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001364111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty