Provider Demographics
NPI:1710058490
Name:LEESBURG CHIROPRACTIC AND MASSAGE, P.L.L.C.
Entity Type:Organization
Organization Name:LEESBURG CHIROPRACTIC AND MASSAGE, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-777-4840
Mailing Address - Street 1:36 CATOCTIN CIR SE STE F
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:703-777-7130
Practice Address - Street 1:36 CATOCTIN CIR SE STE F
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3632
Practice Address - Country:US
Practice Address - Phone:703-777-4840
Practice Address - Fax:703-777-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty