Provider Demographics
NPI:1841538444
Name:SPORTS AND FAMILY CHIROPRACTIC OF VA
Entity type:Organization
Organization Name:SPORTS AND FAMILY CHIROPRACTIC OF VA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAE YONG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-941-2225
Mailing Address - Street 1:7002 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE F
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3200
Mailing Address - Country:US
Mailing Address - Phone:703-941-2225
Mailing Address - Fax:703-941-2224
Practice Address - Street 1:7002 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE F
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3200
Practice Address - Country:US
Practice Address - Phone:703-941-2225
Practice Address - Fax:703-941-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty