Healthcare Provider Details

I. General information

NPI: 1710672639
Provider Name (Legal Business Name): DMV IRON WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6763R WILSON BLVD
FALLS CHURCH VA
22044-3302
US

IV. Provider business mailing address

6763R WILSON BLVD
FALLS CHURCH VA
22044-3302
US

V. Phone/Fax

Practice location:
  • Phone: 703-336-9294
  • Fax:
Mailing address:
  • Phone: 703-336-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: XIMENA NATALIA RODRIGUEZ LUJAN
Title or Position: ATHLETIC TRAINER
Credential: ATC, LAT
Phone: 202-341-7239