Healthcare Provider Details

I. General information

NPI: 1184140501
Provider Name (Legal Business Name): CHRISTOPHER GRIVAS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W ANNANDALE ROAD SUITE 300
FALLS CHURCH VA
22046
US

IV. Provider business mailing address

510 W ANNANDALE RD STE 300
FALLS CHURCH VA
22046-4226
US

V. Phone/Fax

Practice location:
  • Phone: 703-600-8208
  • Fax:
Mailing address:
  • Phone: 703-600-8208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104557417
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: