Provider Demographics
NPI:1245302454
Name:ADVANCED BACK AND NECK PAIN CENTER
Entity type:Organization
Organization Name:ADVANCED BACK AND NECK PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZIEGLER
Authorized Official - Suffix:III
Authorized Official - Credentials:DC FIAMA
Authorized Official - Phone:703-521-0644
Mailing Address - Street 1:46 SOUTH GLEBE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204
Mailing Address - Country:US
Mailing Address - Phone:703-521-0644
Mailing Address - Fax:703-521-9413
Practice Address - Street 1:46 SOUTH GLEBE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204
Practice Address - Country:US
Practice Address - Phone:703-521-0644
Practice Address - Fax:703-521-9413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000939111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
176534OtherANTHEM
37860004OtherBCBS
861845Medicare ID - Type Unspecified