Healthcare Provider Details

I. General information

NPI: 1720306079
Provider Name (Legal Business Name): DC INJURY CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 8TH ST NE
WASHINGTON DC
20002-5228
US

IV. Provider business mailing address

400 8TH ST NE
WASHINGTON DC
20002-5228
US

V. Phone/Fax

Practice location:
  • Phone: 202-546-7246
  • Fax:
Mailing address:
  • Phone: 202-546-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH030059
License Number StateDC

VIII. Authorized Official

Name: DR. NESLY CLERGE
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 202-546-7246