Provider Demographics
NPI:1265675250
Name:GOOD DAY TOTAL HEALTH CLINIC PC
Entity Type:Organization
Organization Name:GOOD DAY TOTAL HEALTH CLINIC PC
Other - Org Name:GOOD DAY CHIROPRACTIC HEALTH CLINIC PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WONHYE
Authorized Official - Middle Name:
Authorized Official - Last Name:SON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-914-4663
Mailing Address - Street 1:8603 WESTWOOD CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2230
Mailing Address - Country:US
Mailing Address - Phone:703-914-4663
Mailing Address - Fax:703-914-4665
Practice Address - Street 1:8603 WESTWOOD CENTER DR STE 200
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2230
Practice Address - Country:US
Practice Address - Phone:703-914-4663
Practice Address - Fax:703-914-4665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556123111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV06565Medicare UPIN