Provider Demographics
NPI:1831591981
Name:LOVESPINE CHIROPRACTIC CLINIC II, INC.
Entity type:Organization
Organization Name:LOVESPINE CHIROPRACTIC CLINIC II, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HYUNG
Authorized Official - Middle Name:HOON
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-429-4622
Mailing Address - Street 1:14161 ROBERT PARIS CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-4238
Mailing Address - Country:US
Mailing Address - Phone:703-429-4622
Mailing Address - Fax:703-429-4623
Practice Address - Street 1:14161 ROBERT PARIS CT
Practice Address - Street 2:SUITE B
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-4238
Practice Address - Country:US
Practice Address - Phone:703-429-4622
Practice Address - Fax:703-429-4623
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOVESPINE CHIROPRACTIC CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-19
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557204111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty