Provider Demographics
NPI:1376957712
Name:CHIRO PHYSICAL MEDICINE LLC
Entity Type:Organization
Organization Name:CHIRO PHYSICAL MEDICINE LLC
Other - Org Name:BALLSTON CHIROPRACTIC & ACCUPUNCTURE
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING AGENCY
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:DELIKAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-350-7939
Mailing Address - Street 1:3801 FAIRFAX DR STE 12
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1762
Mailing Address - Country:US
Mailing Address - Phone:570-350-7939
Mailing Address - Fax:570-291-5012
Practice Address - Street 1:3801 FAIRFAX DR STE 12
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1762
Practice Address - Country:US
Practice Address - Phone:570-350-7939
Practice Address - Fax:570-291-5012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty