Provider Demographics
NPI:1235481623
Name:ADDIS CHIROPRACTIC & PHYSICAL MEDICINE
Entity Type:Organization
Organization Name:ADDIS CHIROPRACTIC & PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BERHANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHIFERAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-379-4055
Mailing Address - Street 1:3541 W BRADDOCK RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1915
Mailing Address - Country:US
Mailing Address - Phone:703-379-4055
Mailing Address - Fax:703-379-1099
Practice Address - Street 1:3541 W BRADDOCK RD
Practice Address - Street 2:SUITE 203
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1915
Practice Address - Country:US
Practice Address - Phone:703-379-4055
Practice Address - Fax:703-379-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty