Healthcare Provider Details

I. General information

NPI: 1790917540
Provider Name (Legal Business Name): ACCIDENT, INJURY & PAIN WELLNESS CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 JEFFERSON DAVIS HWY SUITE 200B
FREDERICKSBURG VA
22401-6213
US

IV. Provider business mailing address

1965 JEFFERSON DAVIS HWY SUITE 200B
FREDERICKSBURG VA
22401-6213
US

V. Phone/Fax

Practice location:
  • Phone: 540-373-1303
  • Fax: 540-373-6061
Mailing address:
  • Phone: 540-373-1303
  • Fax: 540-373-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104555914
License Number StateVA

VIII. Authorized Official

Name: DR. HEATHER RENE O'QUINN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 540-373-1303