Provider Demographics
NPI:1700170024
Name:SOUTH RIDING SPINE AND THERAPY
Entity Type:Organization
Organization Name:SOUTH RIDING SPINE AND THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLEIFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-541-7111
Mailing Address - Street 1:43130 AMBERWOOD PLZ
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SOUTH RIDING
Mailing Address - State:VA
Mailing Address - Zip Code:20152-4105
Mailing Address - Country:US
Mailing Address - Phone:703-541-7111
Mailing Address - Fax:
Practice Address - Street 1:43130 AMBERWOOD PLZ
Practice Address - Street 2:SUITE 130
Practice Address - City:SOUTH RIDING
Practice Address - State:VA
Practice Address - Zip Code:20152-4105
Practice Address - Country:US
Practice Address - Phone:703-541-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000685111N00000X
VA0104001121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty