Provider Demographics
NPI:1619988078
Name:WELCH, CARRIE SUE (DC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:SUE
Last Name:WELCH
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 1:12359 SUNRISE VALLEY DR.
Mailing Address - Street 2:SUITE #140
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191
Mailing Address - Country:US
Mailing Address - Phone:703-476-8700
Mailing Address - Fax:703-476-1825
Practice Address - Street 1:12359 SUNRISE VALLEY DR
Practice Address - Street 2:SUITE #140
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3462
Practice Address - Country:US
Practice Address - Phone:703-476-8700
Practice Address - Fax:703-476-1825
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7405325OtherAETNA NON-HMO PROVIDER #
VAK5140001OtherCARE FIRST
147206OtherBLUE CROSS/BLUE SHIELD
VA3714926OtherAETNA HMO PROVDIER #