Healthcare Provider Details

I. General information

NPI: 1275201774
Provider Name (Legal Business Name): A&C CLINICAL MANIPULATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 STERLING RD STE 105
HERNDON VA
20170-3837
US

IV. Provider business mailing address

5104 CASTLE HARBOR WAY
CENTREVILLE VA
20120-4140
US

V. Phone/Fax

Practice location:
  • Phone: 703-855-3514
  • Fax:
Mailing address:
  • Phone: 703-855-3514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: KIYOSHI YAMAMOTO
Title or Position: ACUPUNCTURIST / OWNER
Credential: LAC., LMT
Phone: 703-855-3514