Provider Demographics
NPI:1649359670
Name:CHRYSALIS CHIROPRACTIC OF ALEXANDRIA, INC
Entity type:Organization
Organization Name:CHRYSALIS CHIROPRACTIC OF ALEXANDRIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOLA
Authorized Official - Middle Name:JUANITA
Authorized Official - Last Name:CAPPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-535-7881
Mailing Address - Street 1:3140 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-2712
Mailing Address - Country:US
Mailing Address - Phone:703-535-7881
Mailing Address - Fax:703-535-7882
Practice Address - Street 1:3140 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-2712
Practice Address - Country:US
Practice Address - Phone:703-535-7881
Practice Address - Fax:703-535-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG02187Medicare ID - Type Unspecified