MEDICARE: VINA CHIROPRACTIC CLINIC

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	0104001995	VA

General Provider Information

NPI Number	:	1679963516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINA CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	6404 SEVEN CORNERS PLACE
Second Line	:	STE.M
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044
Country	:	US
Telephone Number	:	703-538-8881
Fax Number	:	703-538-8895

Provider Business Practice Location Address
First Line	:	6404 SEVEN CORNERS PL
Second Line	:	STE.M
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2010
Country	:	US
Telephone Number	:	703-538-8881
Fax Number	:	703-538-8895

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. DIANNA PHAN
Credential	:
Telephone Number	:	703-538-8881

Provider Enumeration Date	:	01/30/2015
Last Update Date	:	01/30/2015

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