Provider Demographics
NPI:1437233483
Name:MCNICHOLAS, BRIAN SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SCOTT
Last Name:MCNICHOLAS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 CLUBHOUSE RD
Mailing Address - Street 2:#102
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4595
Mailing Address - Country:US
Mailing Address - Phone:703-435-8805
Mailing Address - Fax:
Practice Address - Street 1:1712 CLUBHOUSE RD
Practice Address - Street 2:#102
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4595
Practice Address - Country:US
Practice Address - Phone:703-435-8805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001891111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF743-0001OtherCAREFIRST BCBS
VA333984OtherANTHEM BCBS VIRGINIA
VA5209702OtherAETNA PPO VIRGINIA
VA3441318-001OtherCIGNA (PPO) VIRGINIA
VA3441318-001OtherCIGNA (PPO) VIRGINIA