Provider Demographics
NPI:1932289220
Name:FAMILY CHIROPRACTIC CENTER OF FAIRFAX INC.
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC CENTER OF FAIRFAX INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-273-7733
Mailing Address - Street 1:10831 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4701
Mailing Address - Country:US
Mailing Address - Phone:703-273-7733
Mailing Address - Fax:703-385-9693
Practice Address - Street 1:10831 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4701
Practice Address - Country:US
Practice Address - Phone:703-273-7733
Practice Address - Fax:703-385-9693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty