Provider Demographics
NPI:1518474626
Name:AUTO INJURY REHAB CENTER, LLC
Entity Type:Organization
Organization Name:AUTO INJURY REHAB CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SU MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-325-4390
Mailing Address - Street 1:7535 LITTLE RIVER TPKE STE 100C
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2976
Mailing Address - Country:US
Mailing Address - Phone:703-214-1000
Mailing Address - Fax:
Practice Address - Street 1:7535 LITTLE RIVER TPKE STE 100C
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2976
Practice Address - Country:US
Practice Address - Phone:703-214-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty