Provider Demographics
NPI:1235177908
Name:WICHIN, RONALD CHARLES (DC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:CHARLES
Last Name:WICHIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 ELDEN ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4825
Mailing Address - Country:US
Mailing Address - Phone:703-834-1910
Mailing Address - Fax:703-834-2609
Practice Address - Street 1:104 ELDEN ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4871
Practice Address - Country:US
Practice Address - Phone:703-834-1910
Practice Address - Fax:703-834-2609
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA050949OtherBLUE CROSS BLUE SHIELD
VA049033Medicare ID - Type Unspecified