Provider Demographics
NPI:1609182088
Name:MANASSAS SPINE & SPORT PC
Entity Type:Organization
Organization Name:MANASSAS SPINE & SPORT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:OHARA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-368-8800
Mailing Address - Street 1:9210 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5513
Mailing Address - Country:US
Mailing Address - Phone:703-368-8800
Mailing Address - Fax:703-368-1281
Practice Address - Street 1:9210 LEE AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5513
Practice Address - Country:US
Practice Address - Phone:703-368-8800
Practice Address - Fax:703-368-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001121111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty