Provider Demographics
NPI:1417276742
Name:MAIMONIDES CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MAIMONIDES CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:MS
Authorized Official - Last Name:STATMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC DI CCP
Authorized Official - Phone:703-383-1630
Mailing Address - Street 1:10807 MAIN ST STE 800
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4730
Mailing Address - Country:US
Mailing Address - Phone:703-383-1630
Mailing Address - Fax:703-383-1631
Practice Address - Street 1:10807 MAIN ST STE 800
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4730
Practice Address - Country:US
Practice Address - Phone:703-383-1630
Practice Address - Fax:703-383-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA490261Medicare PIN