Healthcare Provider Details

I. General information

NPI: 1356171466
Provider Name (Legal Business Name): ERICK GAITAN DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 CONNECTICUT AVE NW
WASHINGTON DC
20008-1155
US

IV. Provider business mailing address

7911 WESTPARK DR APT 928
MC LEAN VA
22102-4283
US

V. Phone/Fax

Practice location:
  • Phone: 202-265-6000
  • Fax:
Mailing address:
  • Phone: 202-813-0445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERICK GAITAN
Title or Position: PRESIDENT
Credential: DC
Phone: 202-813-0445