Healthcare Provider Details

I. General information

NPI: 1578482303
Provider Name (Legal Business Name): RACHEL PARK DIPL AC (NCBHAM)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6897 WALNUT HILL DR
GAINESVILLE VA
20155-3020
US

IV. Provider business mailing address

6897 WALNUT HILL DR
GAINESVILLE VA
20155-3020
US

V. Phone/Fax

Practice location:
  • Phone: 301-905-7700
  • Fax:
Mailing address:
  • Phone: 301-905-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121001273
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: