Provider Demographics
NPI:1366859266
Name:CHIROGROUP LLC
Entity Type:Organization
Organization Name:CHIROGROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRINO
Authorized Official - Middle Name:DIOGENES
Authorized Official - Last Name:FLEVOTOMOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-403-8984
Mailing Address - Street 1:5597 SEMINARY RD
Mailing Address - Street 2:2507S
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-3504
Mailing Address - Country:US
Mailing Address - Phone:703-403-8984
Mailing Address - Fax:
Practice Address - Street 1:5597 SEMINARY RD
Practice Address - Street 2:2507S
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3504
Practice Address - Country:US
Practice Address - Phone:703-403-8984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-13
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty