Provider Demographics
NPI:1508122862
Name:CHIROPRACTIC CARE AND REHAB OF NORTHERN VIRGINIA
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE AND REHAB OF NORTHERN VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-644-9311
Mailing Address - Street 1:8136 OLD KEENE MILL ROAD
Mailing Address - Street 2:A-314
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152
Mailing Address - Country:US
Mailing Address - Phone:703-644-9311
Mailing Address - Fax:703-644-3907
Practice Address - Street 1:8136 OLD KEENE MILL ROAD
Practice Address - Street 2:A-314
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152
Practice Address - Country:US
Practice Address - Phone:703-644-9311
Practice Address - Fax:703-644-3907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
238757Medicare UPIN