Provider Demographics
NPI:1629126016
Name:CHANTILLY CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:CHANTILLY CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:BS DC
Authorized Official - Phone:703-378-2698
Mailing Address - Street 1:3910 CENTREVILLE ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151
Mailing Address - Country:US
Mailing Address - Phone:703-378-2698
Mailing Address - Fax:703-378-1451
Practice Address - Street 1:3910 CENTREVILLE ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151
Practice Address - Country:US
Practice Address - Phone:703-378-2698
Practice Address - Fax:703-378-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001706111N00000X
VA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty