Healthcare Provider Details

I. General information

NPI: 1508544651
Provider Name (Legal Business Name): ROOT & BALANCE ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 ROWELL CT
FALLS CHURCH VA
22046-3126
US

IV. Provider business mailing address

1646 KURPIERS CT
MC LEAN VA
22101-5017
US

V. Phone/Fax

Practice location:
  • Phone: 571-766-8188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUDITH ALLEN
Title or Position: ACUPUNCTURIST
Credential: MS, DIPL.AC., L.AC.
Phone: 703-577-8386