Healthcare Provider Details

I. General information

NPI: 1891027892
Provider Name (Legal Business Name): HEALTH BUILDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540 LITTLE RIVER TPKE SUITE H
ANNANDALE VA
22003-2839
US

IV. Provider business mailing address

7540 LITTLE RIVER TPKE SUITE H
ANNANDALE VA
22003-2839
US

V. Phone/Fax

Practice location:
  • Phone: 703-256-2600
  • Fax: 703-256-6566
Mailing address:
  • Phone: 703-256-2600
  • Fax: 703-256-6566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0104000459
License Number StateVA

VIII. Authorized Official

Name: DR. BRETT E FULLER
Title or Position: DOCTOR
Credential: DC
Phone: 703-256-2600