Provider Demographics
NPI:1497106496
Name:MANASSAS WELLNESS CENTER
Entity Type:Organization
Organization Name:MANASSAS WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:571-359-6285
Mailing Address - Street 1:8735 PLANTATION LN
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4506
Mailing Address - Country:US
Mailing Address - Phone:571-359-6285
Mailing Address - Fax:571-359-6286
Practice Address - Street 1:8735 PLANTATION LN
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4506
Practice Address - Country:US
Practice Address - Phone:571-359-6285
Practice Address - Fax:571-359-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-30
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1972522928OtherTYPE 1 NPI