Healthcare Provider Details

I. General information

NPI: 1548382492
Provider Name (Legal Business Name): BACK 2 BACK CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12847 BRAEMAR VILLAGE PLZ
BRISTOW VA
20136-5502
US

IV. Provider business mailing address

12847 BRAEMAR VILLAGE PLZ
BRISTOW VA
20136-5502
US

V. Phone/Fax

Practice location:
  • Phone: 703-365-8333
  • Fax:
Mailing address:
  • Phone: 703-365-8333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104002083
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104002089
License Number StateVA

VIII. Authorized Official

Name: DR. RICHARD WEISS
Title or Position: CHIEF OPERATING OFFICER
Credential: D.C.
Phone: 703-365-8333