Healthcare Provider Details

I. General information

NPI: 1558835967
Provider Name (Legal Business Name): WHOLE HEALTH MEDICAL CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10329 DEMOCRACY LN
FAIRFAX VA
22030-2558
US

IV. Provider business mailing address

10329 DEMOCRACY LN
FAIRFAX VA
22030-2558
US

V. Phone/Fax

Practice location:
  • Phone: 571-357-2229
  • Fax:
Mailing address:
  • Phone: 571-357-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL

VIII. Authorized Official

Name: HONG HITCHINGS
Title or Position: OWNER
Credential:
Phone: 703-901-6588