Healthcare Provider Details

I. General information

NPI: 1467690743
Provider Name (Legal Business Name): T & J CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2009
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10680 MAIN ST SUITE 275
FAIRFAX VA
22030-3810
US

IV. Provider business mailing address

10680 MAIN ST SUITE 275
FAIRFAX VA
22030-3810
US

V. Phone/Fax

Practice location:
  • Phone: 703-539-8822
  • Fax: 703-539-8862
Mailing address:
  • Phone: 703-539-8822
  • Fax: 703-539-8862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556321
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0104556321
License Number StateVA

VIII. Authorized Official

Name: DR. JONG HEE CHO
Title or Position: PRESIDENT
Credential: DC
Phone: 703-539-8822