Provider Demographics
NPI:1336307933
Name:HORIZON CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:HORIZON CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-691-2225
Mailing Address - Street 1:3541 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2793
Mailing Address - Country:US
Mailing Address - Phone:703-691-2225
Mailing Address - Fax:703-691-2265
Practice Address - Street 1:3541 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2793
Practice Address - Country:US
Practice Address - Phone:703-691-2225
Practice Address - Fax:703-691-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA716661OtherMEDICARE LEGACY