Healthcare Provider Details

I. General information

NPI: 1871918201
Provider Name (Legal Business Name): SELEME CHIROPRACTIC AND ALTERNATIVE HEALTHCARE P L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 03/06/2014
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 Code111NN1001X
TaxonomyNutrition Chiropractor
License Number1957
License Number StateVA

VIII. Authorized Official

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