Provider Demographics
NPI:1851702203
Name:COLE SPORTS CHIROPRACTIC & REHAB, LLC
Entity Type:Organization
Organization Name:COLE SPORTS CHIROPRACTIC & REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-273-8068
Mailing Address - Street 1:7371 ATLAS WALK WAY # 270
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-2992
Mailing Address - Country:US
Mailing Address - Phone:540-242-4489
Mailing Address - Fax:540-242-4731
Practice Address - Street 1:385 GARRISONVILLE RD
Practice Address - Street 2:SUITE 121 & 211
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1545
Practice Address - Country:US
Practice Address - Phone:540-242-4489
Practice Address - Fax:540-242-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556795111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV1125AMedicare PIN