Provider Demographics
NPI:1265873848
Name:SHERWOOD HALL CHIROPRACTIC LLC
Entity type:Organization
Organization Name:SHERWOOD HALL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:703-780-9505
Mailing Address - Street 1:2616 SHERWOOD HALL LN
Mailing Address - Street 2:SUITE 406
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3100
Mailing Address - Country:US
Mailing Address - Phone:703-780-9505
Mailing Address - Fax:703-780-9508
Practice Address - Street 1:2616 SHERWOOD HALL LN
Practice Address - Street 2:SUITE 406
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3100
Practice Address - Country:US
Practice Address - Phone:703-780-9505
Practice Address - Fax:703-780-9508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000968111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty