Provider Demographics
NPI:1598992711
Name:WUBANTE, EDEN ALEMAYEHU (DC)
Entity Type:Individual
Prefix:DR
First Name:EDEN
Middle Name:ALEMAYEHU
Last Name:WUBANTE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 QUANTRELL AVE
Mailing Address - Street 2:502
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2715
Mailing Address - Country:US
Mailing Address - Phone:571-234-2969
Mailing Address - Fax:703-379-1099
Practice Address - Street 1:5801 QUANTRELL AVE
Practice Address - Street 2:502
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2715
Practice Address - Country:US
Practice Address - Phone:571-234-2969
Practice Address - Fax:703-379-1099
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor