Healthcare Provider Details

I. General information

NPI: 1871593327
Provider Name (Legal Business Name): BIBHU R MISRA D.C., M.SC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21785 FILIGREE CT SUITE 200
ASHBURN VA
20147-6213
US

IV. Provider business mailing address

21785 FILIGREE CT STE 200
ASHBURN VA
20147-6214
US

V. Phone/Fax

Practice location:
  • Phone: 703-724-9899
  • Fax: 703-724-9897
Mailing address:
  • Phone: 703-724-9899
  • Fax: 703-724-9897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556248
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: