Provider Demographics
NPI:1255908588
Name:EMPOWER CHIROPRACTIC LOUDOUN LLC
Entity type:Organization
Organization Name:EMPOWER CHIROPRACTIC LOUDOUN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LICHTENAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:571-319-6768
Mailing Address - Street 1:43150 BROADLANDS CENTER PLZ STE 154
Mailing Address - Street 2:
Mailing Address - City:BROADLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:20148-3801
Mailing Address - Country:US
Mailing Address - Phone:571-319-6768
Mailing Address - Fax:
Practice Address - Street 1:43150 BROADLANDS CENTER PLZ STE 154
Practice Address - Street 2:
Practice Address - City:BROADLANDS
Practice Address - State:VA
Practice Address - Zip Code:20148-3801
Practice Address - Country:US
Practice Address - Phone:571-319-6768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty