Provider Demographics
NPI:1720060650
Name:ADVANCED CHIROPRACTIC AND REHABILITATION PC
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC AND REHABILITATION PC
Other - Org Name:HAYMARKET CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORIARTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-675-7179
Mailing Address - Street 1:14535 JOHN MARSHALL HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-4024
Mailing Address - Country:US
Mailing Address - Phone:703-753-0974
Mailing Address - Fax:703-753-9709
Practice Address - Street 1:14535 JOHN MARSHALL HIGHWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3839
Practice Address - Country:US
Practice Address - Phone:703-753-0974
Practice Address - Fax:703-753-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08923Medicare PIN
VAC08923Medicare PIN