Provider Demographics
NPI:1245335884
Name:PAGE, GREGORY ALDEN (BS, DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALDEN
Last Name:PAGE
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 CENTREVILLE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3279
Mailing Address - Country:US
Mailing Address - Phone:703-378-2698
Mailing Address - Fax:703-378-1451
Practice Address - Street 1:3910 CENTREVILLE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3279
Practice Address - Country:US
Practice Address - Phone:703-378-2698
Practice Address - Fax:703-378-1451
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1621623OtherFIRST HEALTH PROVIDER ID#
VA2135574OtherMAMSI PROVIDER ID #
VA3320837OtherAETNA HMO PROVIDER #
VA5558699OtherAETNA NON-HMO PROVIDER #
VA1621623OtherMAILHANDLERS PROVIDER #
VA1002386OtherASHN PROVIDER ID #
VA2054609OtherUNITED HEALTH CARE ID#
VA237552OtherANTHEM PROVIDER ID#
VA109A-PAOtherCAREFIRST BCBS PROVIDER #
VA2135574OtherOPTIMUM CHOICE PROVIDER #
VA2135574OtherALLIANCE PROVIDER ID#
VA2135574OtherMDIPA PROVIDER #
VA5226527OtherCCN PROVIDER #
VAJ153OtherCAREFIRST BCBS PROVIDER #
VA2135574OtherOPTIMUM CHOICE PROVIDER #
VAC08971Medicare ID - Type UnspecifiedMEDICARE GROUP #