Provider Demographics
NPI:1437508736
Name:MOON, SOOJOON (DC,LAC)
Entity Type:Individual
Prefix:DR
First Name:SOOJOON
Middle Name:
Last Name:MOON
Suffix:
Gender:M
Credentials:DC,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8303 ARLINGTON BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2903
Mailing Address - Country:US
Mailing Address - Phone:703-573-4773
Mailing Address - Fax:703-573-2252
Practice Address - Street 1:8303 ARLINGTON BLVD
Practice Address - Street 2:STE 202
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2903
Practice Address - Country:US
Practice Address - Phone:703-573-4773
Practice Address - Fax:703-573-2252
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor