Healthcare Provider Details

I. General information

NPI: 1083222863
Provider Name (Legal Business Name): ADA HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4604 PINECREST OFFICE PARK DR STE G
ALEXANDRIA VA
22312-1441
US

IV. Provider business mailing address

6434 MAPLEWOOD DR
FALLS CHURCH VA
22041-1230
US

V. Phone/Fax

Practice location:
  • Phone: 240-821-2744
  • Fax:
Mailing address:
  • Phone: 240-821-2744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAN LI
Title or Position: AO/OWNER
Credential: L.AC
Phone: 240-821-2744