Provider Demographics
NPI:1831401561
Name:BAEK, EDWARD SEUNG-WON (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SEUNG-WON
Last Name:BAEK
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 1:6134 REDWOOD SQUARE CENTER
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2642
Mailing Address - Country:US
Mailing Address - Phone:703-543-6788
Mailing Address - Fax:703-543-4778
Practice Address - Street 1:6134 REDWOOD SQUARE CENTER
Practice Address - Street 2:SUITE 101
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2642
Practice Address - Country:US
Practice Address - Phone:703-543-6788
Practice Address - Fax:703-543-4778
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor