MEDICARE: ALEXANDRIA BACK & NECK CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0104000973	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4465301	OTHER	VA	AETNA
2	093746	OTHER	VA	ANTHEM BC/BS INDIVIDUAL #
3	093882	OTHER	VA	ANTHEM BC/BS GROUP #
4	2431906	OTHER	VA	AETNA

General Provider Information

NPI Number	:	1063596807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEXANDRIA BACK & NECK CENTER

Provider Business Mailing Address
First Line	:	7770 RICHMOND HWY STE D
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-2859
Country	:	US
Telephone Number	:	703-360-1011
Fax Number	:	703-360-1075

Provider Business Practice Location Address
First Line	:	7770 RICHMOND HWY STE D
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-2859
Country	:	US
Telephone Number	:	703-360-1011
Fax Number	:	703-360-1075

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CURTIS C. MARGERUM
Credential	:	D.C.
Telephone Number	:	703-360-1011

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	05/09/2008

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Directions to “ALEXANDRIA BACK & NECK CENTER ” Practice Location

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