Provider Demographics
NPI:1609214659
Name:CAPITAL CHIROPRACTIC
Entity Type:Organization
Organization Name:CAPITAL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:CRAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-544-7475
Mailing Address - Street 1:11835 SKYLARK RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-9375
Mailing Address - Country:US
Mailing Address - Phone:703-544-7475
Mailing Address - Fax:
Practice Address - Street 1:518 N HENRY ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2233
Practice Address - Country:US
Practice Address - Phone:703-544-7475
Practice Address - Fax:888-428-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty