Provider Demographics
NPI:1265903751
Name:NOVA SPINE & REHAB CENTER INC.
Entity type:Organization
Organization Name:NOVA SPINE & REHAB CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMELLINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-739-5850
Mailing Address - Street 1:5811 HAMPTON FOREST WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7254
Mailing Address - Country:US
Mailing Address - Phone:410-739-5850
Mailing Address - Fax:
Practice Address - Street 1:803 W BROAD ST STE 240A
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3108
Practice Address - Country:US
Practice Address - Phone:703-606-2013
Practice Address - Fax:703-237-2839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty