Healthcare Provider Details

I. General information

NPI: 1760149272
Provider Name (Legal Business Name): ASHBURN NATURAL WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20915 ASHBURN RD STE 235
ASHBURN VA
20147-5678
US

IV. Provider business mailing address

20915 ASHBURN RD STE 235
ASHBURN VA
20147-5678
US

V. Phone/Fax

Practice location:
  • Phone: 703-544-9355
  • Fax: 571-918-0613
Mailing address:
  • Phone: 703-544-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: TIFFANIE LE
Title or Position: OWNER
Credential: DC
Phone: 703-544-9355