Healthcare Provider Details

I. General information

NPI: 1992712541
Provider Name (Legal Business Name): VASELES ASIMACOPOULOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 SALEM RUN BLVD SUITE 100
FREDERICKSBURG VA
22407-7119
US

IV. Provider business mailing address

12200 AMOS LN
FREDERICKSBURG VA
22407-7107
US

V. Phone/Fax

Practice location:
  • Phone: 540-726-4882
  • Fax: 540-786-4893
Mailing address:
  • Phone: 540-786-4882
  • Fax: 540-786-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104555602
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: