Provider Demographics
NPI:1245247832
Name:ASIMACOPOULOS, LLC
Entity type:Organization
Organization Name:ASIMACOPOULOS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VASELES
Authorized Official - Middle Name:
Authorized Official - Last Name:ASIMACOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-786-4882
Mailing Address - Street 1:5705 SALEM RUN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-7119
Mailing Address - Country:US
Mailing Address - Phone:540-786-4882
Mailing Address - Fax:540-786-4893
Practice Address - Street 1:5705 SALEM RUN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-7119
Practice Address - Country:US
Practice Address - Phone:540-786-4882
Practice Address - Fax:540-786-4893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherFEDERAL TAX NUMBER