Provider Demographics
NPI:1710244728
Name:COMMONWEALTH FAMILY HEALTH CARE
Entity Type:Organization
Organization Name:COMMONWEALTH FAMILY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-323-8500
Mailing Address - Street 1:5216 ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1639
Mailing Address - Country:US
Mailing Address - Phone:703-323-8500
Mailing Address - Fax:703-323-4176
Practice Address - Street 1:5216 ROLLING RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1639
Practice Address - Country:US
Practice Address - Phone:703-323-8500
Practice Address - Fax:703-323-4176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-15
Last Update Date:2012-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001811111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA491210Medicare PIN