Provider Demographics
NPI:1366856296
Name:LEE A. BAZZARONE, DC INC.
Entity Type:Organization
Organization Name:LEE A. BAZZARONE, DC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BAZZARONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-938-9300
Mailing Address - Street 1:2557 CHAIN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-5517
Mailing Address - Country:US
Mailing Address - Phone:703-938-9300
Mailing Address - Fax:703-938-0694
Practice Address - Street 1:2557 CHAIN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22181-5517
Practice Address - Country:US
Practice Address - Phone:703-938-9300
Practice Address - Fax:703-938-0694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000764111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T91669Medicare UPIN