Provider Demographics
NPI:1770604464
Name:BACK 2 BACK CHIROPRACTIC
Entity type:Organization
Organization Name:BACK 2 BACK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-378-8633
Mailing Address - Street 1:4124 WALNEY ROAD, SUITE N
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1601
Mailing Address - Country:US
Mailing Address - Phone:703-378-8633
Mailing Address - Fax:703-378-7388
Practice Address - Street 1:14029 LEE JACKSON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1601
Practice Address - Country:US
Practice Address - Phone:703-378-8633
Practice Address - Fax:703-378-7388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002089111N00000X
VA0104002083111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty