Healthcare Provider Details

I. General information

NPI: 1528136967
Provider Name (Legal Business Name): SPINE CARE OF ALEXANDRIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6285 FRANCONIA RD
ALEXANDRIA VA
22310-2510
US

IV. Provider business mailing address

6285 FRANCONIA RD
ALEXANDRIA VA
22310-2510
US

V. Phone/Fax

Practice location:
  • Phone: 703-719-7302
  • Fax: 703-719-9462
Mailing address:
  • Phone: 703-719-7302
  • Fax: 703-719-9462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number0104001006
License Number StateVA

VIII. Authorized Official

Name: MRS. KATHERINE MICHELLE UNDERWOOD
Title or Position: OFFICE MANAGER
Credential:
Phone: 703-719-7302