Provider Demographics
NPI:1467691048
Name:RONALD C WICHIN DC PC
Entity Type:Organization
Organization Name:RONALD C WICHIN DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:WICHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-834-1910
Mailing Address - Street 1:104 ELDEN ST STE 14
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4825
Mailing Address - Country:US
Mailing Address - Phone:703-834-1910
Mailing Address - Fax:703-834-2609
Practice Address - Street 1:104 ELDEN ST STE 14
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4825
Practice Address - Country:US
Practice Address - Phone:703-834-1910
Practice Address - Fax:703-834-2609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
149505Medicare PIN