Healthcare Provider Details

I. General information

NPI: 1396954608
Provider Name (Legal Business Name): BENJAMIN DAVID HOPSICKER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 KINGSTOWNE VILLAGE PKWY SUITE 100
ALEXANDRIA VA
22315-5880
US

IV. Provider business mailing address

5901 KINGSTOWNE VILLAGE PKWY STE 100
ALEXANDRIA VA
22315-5881
US

V. Phone/Fax

Practice location:
  • Phone: 703-347-7530
  • Fax: 703-347-7531
Mailing address:
  • Phone: 703-347-7530
  • Fax: 703-347-7531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556533
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: