Provider Demographics
NPI:1457319907
Name:CLEGG CHIROPRACTIC P C
Entity Type:Organization
Organization Name:CLEGG CHIROPRACTIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLEGG
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:703-777-8884
Mailing Address - Street 1:225 LOUDOUN ST SE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3115
Mailing Address - Country:US
Mailing Address - Phone:703-777-8884
Mailing Address - Fax:703-777-9071
Practice Address - Street 1:225 LOUDOUN ST SE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3115
Practice Address - Country:US
Practice Address - Phone:703-777-8884
Practice Address - Fax:703-777-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAE-00111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08546Medicare ID - Type UnspecifiedGROUP NUMBER