Provider Demographics
NPI:1730680166
Name:BORTHAKUR, DEBARUN (DC)
Entity Type:Individual
Prefix:
First Name:DEBARUN
Middle Name:
Last Name:BORTHAKUR
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 1:20 PIDGEON HILL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6134
Mailing Address - Country:US
Mailing Address - Phone:703-444-4141
Mailing Address - Fax:703-441-5407
Practice Address - Street 1:20 PIDGEON HILL DR STE 102
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6134
Practice Address - Country:US
Practice Address - Phone:703-444-4141
Practice Address - Fax:703-441-5407
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor