Healthcare Provider Details

I. General information

NPI: 1164575056
Provider Name (Legal Business Name): UNITED CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 10/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 HERNDON PKWY SUITE B
HERNDON VA
20170-5536
US

IV. Provider business mailing address

905 HERNDON PKWY SUITE B
HERNDON VA
20170-5536
US

V. Phone/Fax

Practice location:
  • Phone: 703-437-8195
  • Fax: 703-437-2404
Mailing address:
  • Phone: 703-437-8195
  • Fax: 703-437-2404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number0104001895
License Number StateVA

VIII. Authorized Official

Name: DR. HIRAD NAJAFBAGY
Title or Position: PRESIDENT
Credential: D.C.
Phone: 703-437-8195