Provider Demographics
NPI:1619064433
Name:HAUPT, ALICIA ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:ANN
Last Name:HAUPT
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 1:14109 CLATTERBUCK LOOP
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-4494
Mailing Address - Country:US
Mailing Address - Phone:703-753-1995
Mailing Address - Fax:703-753-1996
Practice Address - Street 1:7439 NEW LINTON HALL ROAD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155
Practice Address - Country:US
Practice Address - Phone:703-753-8080
Practice Address - Fax:703-753-8011
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001307111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA218177OtherANTHEM BCBS
VA350001180Medicare ID - Type Unspecified