Healthcare Provider Details

I. General information

NPI: 1639242779
Provider Name (Legal Business Name): NEIL PATRICK MCLAUGHLIN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11495 SUNSET HILLS RD STE 240
RESTON VA
20190-5257
US

IV. Provider business mailing address

11424 NIGHT STAR WAY
RESTON VA
20194-1011
US

V. Phone/Fax

Practice location:
  • Phone: 703-742-7856
  • Fax: 703-742-4064
Mailing address:
  • Phone: 703-437-4218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number0104000976
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: