Provider Demographics
NPI:1972600526
Name:WASHINGTON SPINE AND INJURY CENTER P C
Entity Type:Organization
Organization Name:WASHINGTON SPINE AND INJURY CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEZAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVANMARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:202-882-4410
Mailing Address - Street 1:3909 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-5880
Mailing Address - Country:US
Mailing Address - Phone:202-882-4410
Mailing Address - Fax:202-882-4412
Practice Address - Street 1:3909 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5880
Practice Address - Country:US
Practice Address - Phone:202-882-4410
Practice Address - Fax:202-882-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCH030042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty