Provider Demographics
NPI:1669689238
Name:OLD DOMINION CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:OLD DOMINION CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:703-760-7606
Mailing Address - Street 1:6257 OLD DOMINION DR
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4821
Mailing Address - Country:US
Mailing Address - Phone:703-760-7606
Mailing Address - Fax:703-760-4969
Practice Address - Street 1:6257 OLD DOMINION DR
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4821
Practice Address - Country:US
Practice Address - Phone:703-760-7606
Practice Address - Fax:703-760-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty