Healthcare Provider Details

I. General information

NPI: 1154455079
Provider Name (Legal Business Name): SKOPP CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 BELLE VIEW BLVD APT A1
ALEXANDRIA VA
22307-6723
US

IV. Provider business mailing address

1701 BELLE VIEW BLVD APT A1
ALEXANDRIA VA
22307-6723
US

V. Phone/Fax

Practice location:
  • Phone: 703-721-9600
  • Fax: 703-768-3290
Mailing address:
  • Phone: 703-721-9600
  • Fax: 703-768-3290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number0104001086
License Number StateVA

VIII. Authorized Official

Name: DR. MARTIN J SKOPP
Title or Position: DOCTOR
Credential: DC
Phone: 703-721-9600