Healthcare Provider Details

I. General information

NPI: 1851539118
Provider Name (Legal Business Name): CARMEL DEKEL WISEMAN D.C., D.I.C.C.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2009
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10807 MAIN ST 800
FAIRFAX VA
22030-4730
US

IV. Provider business mailing address

13988 NEW BRADDOCK RD
CENTREVILLE VA
20121-3502
US

V. Phone/Fax

Practice location:
  • Phone: 240-460-5150
  • Fax: 240-342-3434
Mailing address:
  • Phone: 240-460-5150
  • Fax: 240-342-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number0104556504
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberS03521
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: