Healthcare Provider Details

I. General information

NPI: 1659697597
Provider Name (Legal Business Name): BREEN CHIROPRACTIC CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8565 SUDLEY RD STE A
MANASSAS VA
20110-3864
US

IV. Provider business mailing address

8565 SUDLEY RD STE A
MANASSAS VA
20110-3864
US

V. Phone/Fax

Practice location:
  • Phone: 703-368-4040
  • Fax: 703-361-1177
Mailing address:
  • Phone: 703-368-4040
  • Fax: 703-361-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104000765
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0104000765
License Number StateVA

VIII. Authorized Official

Name: ROBERT W BREEN
Title or Position: PRESIDENT
Credential: DC
Phone: 703-368-4040