Provider Demographics
NPI:1932681277
Name:EMPOWER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:EMPOWER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHTENAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:571-406-4102
Mailing Address - Street 1:9649 FAIRFAX BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2321
Mailing Address - Country:US
Mailing Address - Phone:571-406-4102
Mailing Address - Fax:
Practice Address - Street 1:9649 FAIRFAX BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2321
Practice Address - Country:US
Practice Address - Phone:571-406-4102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty