Provider Demographics
NPI:1932208832
Name:CENTREVILLE CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:CENTREVILLE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:T
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-266-0505
Mailing Address - Street 1:13880 BRADDOCK RD STE 108
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2460
Mailing Address - Country:US
Mailing Address - Phone:703-266-0505
Mailing Address - Fax:703-266-2506
Practice Address - Street 1:13880 BRADDOCK RD STE 108
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2460
Practice Address - Country:US
Practice Address - Phone:703-266-0505
Practice Address - Fax:703-266-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104002012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA494517OtherMAMSI
VA463363OtherBC/BS
VA463363OtherBC/BS