Provider Demographics
NPI:1295460863
Name:SOLANO SPINE & SPORT
Entity Type:Organization
Organization Name:SOLANO SPINE & SPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-536-4366
Mailing Address - Street 1:803 W BROAD ST STE 620
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3133
Mailing Address - Country:US
Mailing Address - Phone:703-536-4366
Mailing Address - Fax:703-536-7933
Practice Address - Street 1:803 W BROAD ST STE 620
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3133
Practice Address - Country:US
Practice Address - Phone:703-536-4366
Practice Address - Fax:703-536-7933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-19
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty