Provider Demographics
NPI:1922414861
Name:PAINFREE CHIROPRACTIC & REHAB
Entity Type:Organization
Organization Name:PAINFREE CHIROPRACTIC & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WUBANTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-270-9020
Mailing Address - Street 1:6121 LINCOLNIA RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2764
Mailing Address - Country:US
Mailing Address - Phone:703-270-9020
Mailing Address - Fax:703-270-9016
Practice Address - Street 1:6121 LINCOLNIA RD
Practice Address - Street 2:SUITE 106
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2764
Practice Address - Country:US
Practice Address - Phone:703-270-9020
Practice Address - Fax:703-270-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty