Provider Demographics
NPI:1346436078
Name:CANZANO CHIROPRACTIC & WELLNESS CENTER
Entity Type:Organization
Organization Name:CANZANO CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:R
Authorized Official - Last Name:CANZANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-481-6004
Mailing Address - Street 1:423 CARLISLE DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4802
Mailing Address - Country:US
Mailing Address - Phone:703-481-6004
Mailing Address - Fax:703-481-8944
Practice Address - Street 1:423 CARLISLE DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4802
Practice Address - Country:US
Practice Address - Phone:703-481-6004
Practice Address - Fax:703-481-8944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7378225OtherAETNA
VA453264OtherANTHEM BC/BS
VA=========OtherUHC
VA7378225OtherAETNA
VA=========OtherNCPPO
VA00B148C56Medicare PIN
VA453264OtherANTHEM BC/BS