Provider Demographics
NPI:1265069900
Name:GRAVITY SPINE LLC
Entity type:Organization
Organization Name:GRAVITY SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYUNG
Authorized Official - Middle Name:JAE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-520-9980
Mailing Address - Street 1:209 ELDEN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4847
Mailing Address - Country:US
Mailing Address - Phone:703-520-9980
Mailing Address - Fax:571-403-9403
Practice Address - Street 1:209 ELDEN ST STE 302
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4847
Practice Address - Country:US
Practice Address - Phone:703-520-9980
Practice Address - Fax:571-403-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty