Healthcare Provider Details

I. General information

NPI: 1386768000
Provider Name (Legal Business Name): WILFRIED F SANSFAUTE D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 WILSON BLVD STE 1040
ARLINGTON VA
22209-2419
US

IV. Provider business mailing address

1317 S QUINCY ST
ARLINGTON VA
22204-4114
US

V. Phone/Fax

Practice location:
  • Phone: 703-879-5144
  • Fax: 703-879-5860
Mailing address:
  • Phone: 703-879-5144
  • Fax: 703-879-5860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556267
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: