Provider Demographics
NPI:1851735815
Name:WINCHESTER CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:WINCHESTER CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-667-0220
Mailing Address - Street 1:101 BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-6100
Mailing Address - Country:US
Mailing Address - Phone:540-667-0220
Mailing Address - Fax:540-667-6022
Practice Address - Street 1:101 BLOSSOM DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-6100
Practice Address - Country:US
Practice Address - Phone:540-667-0220
Practice Address - Fax:540-667-6022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000318111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10395935OtherCAQH
VA350000013OtherPTAN MEDICARE
VAT21432Medicare UPIN