Healthcare Provider Details

I. General information

NPI: 1083768782
Provider Name (Legal Business Name): CARLTON CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8805 SUDLEY ROAD SUITE 200 A
MANASSAS VA
20110
US

IV. Provider business mailing address

8805 SUDLEY ROAD SUITE 200 A
MANASSAS VA
20110
US

V. Phone/Fax

Practice location:
  • Phone: 703-335-9149
  • Fax: 703-335-9004
Mailing address:
  • Phone: 703-335-9149
  • Fax: 703-335-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104000899
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305004018
License Number StateVA

VIII. Authorized Official

Name: VALERIE LORRAINE SHUMATE
Title or Position: OFFICE MANAGER
Credential:
Phone: 703-335-9149