MEDICARE: BACK 2 BACK CHIROPRACTIC

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	0104002083	VA
2	111N00000X	Chiropractor	0104002089	VA

General Provider Information

NPI Number	:	1548382492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BACK 2 BACK CHIROPRACTIC

Provider Business Mailing Address
First Line	:	12847 BRAEMAR VILLAGE PLZ
Second Line	:
City	:	BRISTOW
State	:	VA
Zip	:	20136-5502
Country	:	US
Telephone Number	:	703-365-8333
Fax Number	:

Provider Business Practice Location Address
First Line	:	12847 BRAEMAR VILLAGE PLZ
Second Line	:
City	:	BRISTOW
State	:	VA
Zip	:	20136-5502
Country	:	US
Telephone Number	:	703-365-8333
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	DR. RICHARD WEISS
Credential	:	D.C.
Telephone Number	:	703-365-8333

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	08/01/2017

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