Provider Demographics
NPI:1679811830
Name:COMPAS CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:COMPAS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COMPAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-598-6818
Mailing Address - Street 1:6940A BRADDOCK ROAD
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:703-333-5022
Mailing Address - Fax:703-333-5023
Practice Address - Street 1:200 PERRINE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2842
Practice Address - Country:US
Practice Address - Phone:732-952-5888
Practice Address - Fax:732-952-5887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty