Provider Demographics
NPI:1437620614
Name:EASTERN ROOTS WELLNESS, PL C
Entity Type:Organization
Organization Name:EASTERN ROOTS WELLNESS, PL C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF ACUPUNCTURE
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:FAGGERT
Authorized Official - Suffix:
Authorized Official - Credentials:DAC, LAC
Authorized Official - Phone:713-354-6643
Mailing Address - Street 1:11017 BYRD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5331
Mailing Address - Country:US
Mailing Address - Phone:804-955-0156
Mailing Address - Fax:
Practice Address - Street 1:1497 CHAIN BRIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5728
Practice Address - Country:US
Practice Address - Phone:571-354-6643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty