Provider Demographics
NPI:1376095372
Name:MCLEAN CHIROPRACTIC, REHAB AND MASSAGE CENTER LLC
Entity Type:Organization
Organization Name:MCLEAN CHIROPRACTIC, REHAB AND MASSAGE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOUBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-662-0220
Mailing Address - Street 1:1340 OLD CHAIN BRIDGE RD
Mailing Address - Street 2:300A
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3955
Mailing Address - Country:US
Mailing Address - Phone:703-662-0220
Mailing Address - Fax:571-814-3268
Practice Address - Street 1:1340 OLD CHAIN BRIDGE RD
Practice Address - Street 2:300A
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3955
Practice Address - Country:US
Practice Address - Phone:703-662-0220
Practice Address - Fax:571-814-3268
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCLEAN CHIROPRACTIC, REHAB AND MASSAGE CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty