Provider Demographics
NPI:1679963516
Name:VINA CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:VINA CHIROPRACTIC CLINIC
Other - Org Name:PHAN, DIANNA AND LU, KY DUC PARTNERSHIP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-538-8881
Mailing Address - Street 1:6404 SEVEN CORNERS PLACE
Mailing Address - Street 2:STE.M
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044
Mailing Address - Country:US
Mailing Address - Phone:703-538-8881
Mailing Address - Fax:703-538-8895
Practice Address - Street 1:6404 SEVEN CORNERS PL
Practice Address - Street 2:STE.M
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2010
Practice Address - Country:US
Practice Address - Phone:703-538-8881
Practice Address - Fax:703-538-8895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001995111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty