Provider Demographics
NPI:1376950576
Name:HOME HEALTH CHIROPRACTIC & PHYSICAL THERAPY
Entity Type:Organization
Organization Name:HOME HEALTH CHIROPRACTIC & PHYSICAL THERAPY
Other - Org Name:TYSONS HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIRREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-706-9093
Mailing Address - Street 1:800 4TH ST SW
Mailing Address - Street 2:APT# S307
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024-3032
Mailing Address - Country:US
Mailing Address - Phone:703-662-3238
Mailing Address - Fax:703-662-5870
Practice Address - Street 1:7787 LEESBURG PIKE
Practice Address - Street 2:SUITE B
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2412
Practice Address - Country:US
Practice Address - Phone:703-662-3238
Practice Address - Fax:703-662-5870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-20
Last Update Date:2014-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556844111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty