Provider Demographics
NPI: | 1760149272 |
---|---|
Name: | ASHBURN NATURAL WELLNESS, LLC |
Entity Type: | Organization |
Organization Name: | ASHBURN NATURAL WELLNESS, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | TIFFANIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 703-544-9355 |
Mailing Address - Street 1: | 20915 ASHBURN RD STE 235 |
Mailing Address - Street 2: | |
Mailing Address - City: | ASHBURN |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 20147-5678 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 703-544-9355 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 20915 ASHBURN RD STE 235 |
Practice Address - Street 2: | |
Practice Address - City: | ASHBURN |
Practice Address - State: | VA |
Practice Address - Zip Code: | 20147-5678 |
Practice Address - Country: | US |
Practice Address - Phone: | 703-544-9355 |
Practice Address - Fax: | 571-918-0613 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-11-18 |
Last Update Date: | 2021-11-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Multi-Specialty | |
No | 171100000X | Other Service Providers | Acupuncturist | Group - Multi-Specialty |