Provider Demographics
NPI:1467579938
Name:LIGHTHOUSE CHIROPRACTIC AND REHAB
Entity Type:Organization
Organization Name:LIGHTHOUSE CHIROPRACTIC AND REHAB
Other - Org Name:ASHBURN SPORT AND SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEAD DOCTOR AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:DOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-723-6614
Mailing Address - Street 1:42882 TRURO PARISH DR STE 207
Mailing Address - Street 2:
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148-4458
Mailing Address - Country:US
Mailing Address - Phone:703-723-6614
Mailing Address - Fax:
Practice Address - Street 1:42882 TRURO PARISH DR STE 207
Practice Address - Street 2:
Practice Address - City:BROADLANDS
Practice Address - State:VA
Practice Address - Zip Code:20148-4458
Practice Address - Country:US
Practice Address - Phone:703-723-6614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555956111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU98407Medicare UPIN