Provider Demographics
NPI:1932585163
Name:GOLDEN CHIRO ACUPUNCTURE CLINIC LLC
Entity Type:Organization
Organization Name:GOLDEN CHIRO ACUPUNCTURE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:703-277-9897
Mailing Address - Street 1:10195 MAIN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3415
Mailing Address - Country:US
Mailing Address - Phone:703-277-9897
Mailing Address - Fax:
Practice Address - Street 1:10195 MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3415
Practice Address - Country:US
Practice Address - Phone:703-277-9897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556491111NR0400X
VA0121000759171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty