Healthcare Provider Details

I. General information

NPI: 1548297484
Provider Name (Legal Business Name): FAMILY CHIROPRACTIC CENTER OF OAKTON, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2972 CHAIN BRIDGE RD STE F
OAKTON VA
22124-3000
US

IV. Provider business mailing address

2972 CHAIN BRIDGE RD STE F
OAKTON VA
22124-3000
US

V. Phone/Fax

Practice location:
  • Phone: 703-938-7555
  • Fax: 703-938-3752
Mailing address:
  • Phone: 703-938-7555
  • Fax: 703-938-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number0104556259
License Number StateVA

VIII. Authorized Official

Name: DR. BRIAN JOSEPH TENSHAW
Title or Position: PRESIDENT
Credential: D.C.
Phone: 703-938-7555