Provider Demographics
NPI:1275201774
Name:A&C CLINICAL MANIPULATION, LLC
Entity Type:Organization
Organization Name:A&C CLINICAL MANIPULATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIYOSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LMT
Authorized Official - Phone:703-855-3514
Mailing Address - Street 1:5104 CASTLE HARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-4140
Mailing Address - Country:US
Mailing Address - Phone:703-855-3514
Mailing Address - Fax:
Practice Address - Street 1:1033 STERLING RD STE 105
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3837
Practice Address - Country:US
Practice Address - Phone:703-855-3514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty