Provider Demographics
NPI:1982771523
Name:ASHBURN VILLAGE CHIROPRACTIC
Entity Type:Organization
Organization Name:ASHBURN VILLAGE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-723-6800
Mailing Address - Street 1:44110 ASHBURN SHOPPING PLZ
Mailing Address - Street 2:SUITE 158
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3999
Mailing Address - Country:US
Mailing Address - Phone:703-723-6800
Mailing Address - Fax:703-723-6777
Practice Address - Street 1:44110 ASHBURN SHOPPING PLZ
Practice Address - Street 2:SUITE 158
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3999
Practice Address - Country:US
Practice Address - Phone:703-723-6800
Practice Address - Fax:703-723-6777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA244466OtherANTHEM BC BS
7299117OtherAETNA PPO
2749530OtherAETNA HMO
8249057OtherCIGNA
505594OtherNCPPO
7110650OtherMAMSI
8249057OtherCIGNA