Provider Demographics
NPI:1720173891
Name:CHICA, JAIME ALBERTO (DC)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:ALBERTO
Last Name:CHICA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 COLUMBIA PIKE
Mailing Address - Street 2:SUITE201
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-5852
Mailing Address - Country:US
Mailing Address - Phone:703-379-6300
Mailing Address - Fax:703-379-4440
Practice Address - Street 1:5555 COLUMBIA PIKE
Practice Address - Street 2:SUITE201
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-5852
Practice Address - Country:US
Practice Address - Phone:703-379-6300
Practice Address - Fax:703-379-4440
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002042111N00000X
FLCH5818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02667D01Medicare PIN