Provider Demographics
NPI:1467530774
Name:VIRGINIA DIAGNOSTIC AND NATURAL MEDICINE CLINIC, PC.
Entity Type:Organization
Organization Name:VIRGINIA DIAGNOSTIC AND NATURAL MEDICINE CLINIC, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUCA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:703-641-4966
Mailing Address - Street 1:2136 GALLOWS RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:DUNN LORING
Mailing Address - State:VA
Mailing Address - Zip Code:22027-1036
Mailing Address - Country:US
Mailing Address - Phone:703-641-4966
Mailing Address - Fax:703-560-0345
Practice Address - Street 1:2136 GALLOWS RD
Practice Address - Street 2:SUITE D
Practice Address - City:DUNN LORING
Practice Address - State:VA
Practice Address - Zip Code:22027-1036
Practice Address - Country:US
Practice Address - Phone:703-641-4966
Practice Address - Fax:703-560-0345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000700111NI0900X
DCCH30005111NI0900X
CADC 18784111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Multi-Specialty