Provider Demographics
NPI:1770512444
Name:WOODBRIDGE CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:WOODBRIDGE CHIROPRACTIC CLINIC, P.C.
Other - Org Name:WOODBRIDGE ACCIDENT & INJURY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-730-7771
Mailing Address - Street 1:13199 CENTERPOINTE WAY
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5284
Mailing Address - Country:US
Mailing Address - Phone:703-730-0200
Mailing Address - Fax:703-730-7771
Practice Address - Street 1:13199 CENTERPOINTE WAY
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5284
Practice Address - Country:US
Practice Address - Phone:703-730-0200
Practice Address - Fax:703-730-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350000123Medicare PIN
VAT21980Medicare UPIN