Healthcare Provider Details

I. General information

NPI: 1982885364
Provider Name (Legal Business Name): SELEME CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10395 DEMOCRACY LN STE A
FAIRFAX VA
22030-2540
US

IV. Provider business mailing address

10395 DEMOCRACY LN STE A
FAIRFAX VA
22030-2540
US

V. Phone/Fax

Practice location:
  • Phone: 703-273-0573
  • Fax: 703-273-7056
Mailing address:
  • Phone: 703-273-0573
  • Fax: 703-273-7056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberVA1957
License Number StateVA

VIII. Authorized Official

Name: DR. VENUS A. SELEME
Title or Position: DOCTOR/OWNER
Credential: D.C.
Phone: 703-273-0573