Provider Demographics
NPI:1235497199
Name:SPINAL HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:SPINAL HEALTH GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOI
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FIAMA
Authorized Official - Phone:703-333-2848
Mailing Address - Street 1:5413 BACKLICK RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-3915
Mailing Address - Country:US
Mailing Address - Phone:703-333-2848
Mailing Address - Fax:703-333-2016
Practice Address - Street 1:5413 BACKLICK RD
Practice Address - Street 2:SUITE E
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3915
Practice Address - Country:US
Practice Address - Phone:703-333-2848
Practice Address - Fax:703-333-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002096111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
490321Medicare PIN