Healthcare Provider Details

I. General information

NPI: 1255972675
Provider Name (Legal Business Name): ELITE PERFORMANCE CHIROPRACTIC AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11503 SUNSET HILLS RD
RESTON VA
20190-4704
US

IV. Provider business mailing address

11503 SUNSET HILLS RD
RESTON VA
20190-4704
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-9355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. SOHEIL CHRISTOPHER RAHBAR
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 703-723-9355