Provider Demographics
NPI:1689772915
Name:LAMPA, MARC FERNANDEZ (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:FERNANDEZ
Last Name:LAMPA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15215 ILLINOIS RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3624
Mailing Address - Country:US
Mailing Address - Phone:678-571-7874
Mailing Address - Fax:
Practice Address - Street 1:2950 DALE BLVD
Practice Address - Street 2:
Practice Address - City:DALE CITY
Practice Address - State:VA
Practice Address - Zip Code:22193-1120
Practice Address - Country:US
Practice Address - Phone:703-583-1222
Practice Address - Fax:703-583-1499
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor