Provider Demographics
NPI:1548382492
Name:BACK 2 BACK CHIROPRACTIC
Entity Type:Organization
Organization Name:BACK 2 BACK CHIROPRACTIC
Other - Org Name:BRAEMAR VILLAGE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-365-8333
Mailing Address - Street 1:12847 BRAEMAR VILLAGE PLZ
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-5502
Mailing Address - Country:US
Mailing Address - Phone:703-365-8333
Mailing Address - Fax:
Practice Address - Street 1:12847 BRAEMAR VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136-5502
Practice Address - Country:US
Practice Address - Phone:703-365-8333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BACK 2 BACK CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-04
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002089111N00000X
VA0104002083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty