Provider Demographics
NPI:1689737611
Name:CHIROPRACTIC CARE INC
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOMAILY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-277-9590
Mailing Address - Street 1:10195 MAIN ST STE F
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3415
Mailing Address - Country:US
Mailing Address - Phone:703-277-9590
Mailing Address - Fax:703-273-6574
Practice Address - Street 1:10195 MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3415
Practice Address - Country:US
Practice Address - Phone:703-277-9590
Practice Address - Fax:703-273-6574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG01625OtherMEDICARE ID
DCV01315Medicare UPIN
DCG01625Medicare PIN