Healthcare Provider Details

I. General information

NPI: 1316192529
Provider Name (Legal Business Name): KING STREET BACK & NECK CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3543 W BRADDOCK RD STE 200
ALEXANDRIA VA
22302-1903
US

IV. Provider business mailing address

PO BOX 75807
CHICAGO IL
60675-5807
US

V. Phone/Fax

Practice location:
  • Phone: 703-578-1900
  • Fax: 703-578-0982
Mailing address:
  • Phone: 703-952-5652
  • Fax: 703-578-0982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104001275
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PHILIP DAVID GOLINSKY
Title or Position: OWNER
Credential: DC
Phone: 703-904-9666