Healthcare Provider Details

I. General information

NPI: 1457319907
Provider Name (Legal Business Name): CLEGG CHIROPRACTIC P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 LOUDOUN ST SE
LEESBURG VA
20175-3115
US

IV. Provider business mailing address

225 LOUDOUN ST SE
LEESBURG VA
20175-3115
US

V. Phone/Fax

Practice location:
  • Phone: 703-777-8884
  • Fax: 703-777-9071
Mailing address:
  • Phone: 703-777-8884
  • Fax: 703-777-9071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberE-00
License Number StateVA

VIII. Authorized Official

Name: DR. CHARLES R. CLEGG
Title or Position: OWNER
Credential: D. C.
Phone: 703-777-8884