Provider Demographics
NPI:1932269057
Name:FAMILY CHIROPRACTIC CENTER OF LAKE RIDGE
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC CENTER OF LAKE RIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-497-2020
Mailing Address - Street 1:12801 DARBY BROOK CT STE 102
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2497
Mailing Address - Country:US
Mailing Address - Phone:703-497-2020
Mailing Address - Fax:703-492-6105
Practice Address - Street 1:12801 DARBY BROOK CT STE 102
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2497
Practice Address - Country:US
Practice Address - Phone:703-497-2020
Practice Address - Fax:703-492-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA215560OtherMDIPA, MAMSI
VA504133OtherNCPPO
VA1023916OtherAETNA HEALTHCARE
VA75190OtherNCAS
VA231686OtherBCBS
VA9430604001OtherCIGNA
VAS398-001OtherCAREFIRST
VA231686OtherBCBS
VA75190OtherNCAS