Provider Demographics
NPI:1750654497
Name:RECHARGE WELLNESS
Entity Type:Organization
Organization Name:RECHARGE WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-781-4400
Mailing Address - Street 1:1041 STERLING RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3869
Mailing Address - Country:US
Mailing Address - Phone:703-481-4400
Mailing Address - Fax:703-935-0430
Practice Address - Street 1:1041 STERLING RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3869
Practice Address - Country:US
Practice Address - Phone:703-481-4400
Practice Address - Fax:703-935-0430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555886111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty