Healthcare Provider Details

I. General information

NPI: 1336123033
Provider Name (Legal Business Name): GARY L SCHOLL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 GUNSTON PLZ # A
LORTON VA
22079-1897
US

IV. Provider business mailing address

63 GLACIER WAY
STAFFORD VA
22554-7753
US

V. Phone/Fax

Practice location:
  • Phone: 703-339-5458
  • Fax: 703-339-0406
Mailing address:
  • Phone: 703-339-5458
  • Fax: 703-339-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number0104556242
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: