Healthcare Provider Details

I. General information

NPI: 1215045067
Provider Name (Legal Business Name): ROBERT A DUCA JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2136 GALLOWS RD SUITE D
DUNN LORING VA
22027-1036
US

IV. Provider business mailing address

2136 GALLOWS RD SUITE D
DUNN LORING VA
22027-1036
US

V. Phone/Fax

Practice location:
  • Phone: 703-641-4966
  • Fax: 703-560-0345
Mailing address:
  • Phone: 703-641-4966
  • Fax: 703-560-0345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License Number0104000700
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License NumberCH30005
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code111NI0900X
TaxonomyInternist Chiropractor
License NumberDC 18784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: