Healthcare Provider Details

I. General information

NPI: 1205036597
Provider Name (Legal Business Name): RAPHA SPINE & NEURO CENTER-ANNANDALE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46161 WESTLAKE DR SUITE 330
POTOMAC FALLS VA
20165-5871
US

IV. Provider business mailing address

46161 WESTLAKE DR SUITE 330
POTOMAC FALLS VA
20165-5871
US

V. Phone/Fax

Practice location:
  • Phone: 703-444-4030
  • Fax: 703-444-4142
Mailing address:
  • Phone: 703-444-4030
  • Fax: 703-444-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104001364
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0104001364
License Number StateVA

VIII. Authorized Official

Name: DR. DANIEL J. LEE
Title or Position: DIRECTOR
Credential: DC
Phone: 703-444-4030