Provider Demographics
NPI:1295037307
Name:FULL MOTION LIFE & SPORT PLLC
Entity Type:Organization
Organization Name:FULL MOTION LIFE & SPORT PLLC
Other - Org Name:OLYA A MORGEN DC PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-536-5900
Mailing Address - Street 1:4815 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2603
Mailing Address - Country:US
Mailing Address - Phone:757-651-2266
Mailing Address - Fax:703-536-5902
Practice Address - Street 1:4815 1ST ST N
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-2603
Practice Address - Country:US
Practice Address - Phone:703-536-5900
Practice Address - Fax:703-536-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty