Healthcare Provider Details

I. General information

NPI: 1487275038
Provider Name (Legal Business Name): ACTIVE RELOAD CHIROPRACTIC AND FUNCTIONAL REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9413 INNOVATION DR
MANASSAS VA
20110-2224
US

IV. Provider business mailing address

1597 SHELDON LN
CATLETT VA
20119-2442
US

V. Phone/Fax

Practice location:
  • Phone: 571-295-5843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT TYLER SCHNITZLER
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 571-295-5843