Provider Demographics
NPI:1851448245
Name:PLATAS CHIROPRACTIC CENTER, LTD.
Entity Type:Organization
Organization Name:PLATAS CHIROPRACTIC CENTER, LTD.
Other - Org Name:SPRINGFIELD CHIROPRACTIC LIFE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PLATAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-451-5600
Mailing Address - Street 1:6225 BRANDON AVE
Mailing Address - Street 2:SUITE 175
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2526
Mailing Address - Country:US
Mailing Address - Phone:703-451-5600
Mailing Address - Fax:703-451-2957
Practice Address - Street 1:6225 BRANDON AVE
Practice Address - Street 2:SUITE 175
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2526
Practice Address - Country:US
Practice Address - Phone:703-451-5600
Practice Address - Fax:703-451-2957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA463198Medicare ID - Type Unspecified
VAU38582Medicare UPIN