Provider Demographics
NPI:1497987184
Name:GREATER LOUDOUN CHIROPRACTIC & WELLNESS CENTER PC
Entity Type:Organization
Organization Name:GREATER LOUDOUN CHIROPRACTIC & WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:540-338-0005
Mailing Address - Street 1:17337 PICKWICK DR STE B
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-6176
Mailing Address - Country:US
Mailing Address - Phone:540-338-0005
Mailing Address - Fax:540-338-0966
Practice Address - Street 1:17337 PICKWICK DR STE B
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6176
Practice Address - Country:US
Practice Address - Phone:540-338-0005
Practice Address - Fax:540-338-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000954111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty