Provider Demographics
NPI:1558567453
Name:ACUTE & WELLNESS CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:ACUTE & WELLNESS CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MIKLUSCAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:703-257-2555
Mailing Address - Street 1:10055 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110
Mailing Address - Country:US
Mailing Address - Phone:703-257-2555
Mailing Address - Fax:703-257-2556
Practice Address - Street 1:10055 WELLINGTON RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:703-257-2555
Practice Address - Fax:703-257-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1134268774OtherIND. NPI#
VAU89116Medicare UPIN
VA1134268774OtherIND. NPI#