Healthcare Provider Details

I. General information

NPI: 1831671155
Provider Name (Legal Business Name): MELISSA OWNBY DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S SAINT ASAPH ST STE D
ALEXANDRIA VA
22314-3177
US

IV. Provider business mailing address

115 S SAINT ASAPH ST STE D
ALEXANDRIA VA
22314-3177
US

V. Phone/Fax

Practice location:
  • Phone: 703-566-6226
  • Fax: 703-566-5266
Mailing address:
  • Phone: 703-566-6226
  • Fax: 703-566-5266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104557500
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: