Provider Demographics
NPI:1720230303
Name:AMERICAN HEALTH AND WELLENSS CENTER, P.C.
Entity Type:Organization
Organization Name:AMERICAN HEALTH AND WELLENSS CENTER, P.C.
Other - Org Name:SPINE HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:GEOFFREY
Authorized Official - Last Name:PETRIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CSCS
Authorized Official - Phone:540-239-9886
Mailing Address - Street 1:5804 WATERMARK CIR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-2952
Mailing Address - Country:US
Mailing Address - Phone:540-239-9886
Mailing Address - Fax:
Practice Address - Street 1:13300 FRANKLIN FARM RD STE B
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4096
Practice Address - Country:US
Practice Address - Phone:703-787-7463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU98319Medicare UPIN