Healthcare Provider Details

I. General information

NPI: 1699145805
Provider Name (Legal Business Name): LOUDOUN FAMILY CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2015
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44330 PREMIER PLZ STE 110
ASHBURN VA
20147-5070
US

IV. Provider business mailing address

44330 PREMIER PLZ STE 110
ASHBURN VA
20147-5070
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-9355
  • Fax: 888-972-7952
Mailing address:
  • Phone: 703-723-9355
  • Fax: 888-972-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556769
License Number StateVA

VIII. Authorized Official

Name: DR. KRISTOPHER ROBERT SCHUSTER
Title or Position: PARTNER
Credential: D.C.
Phone: 571-331-8710