Healthcare Provider Details

I. General information

NPI: 1235497199
Provider Name (Legal Business Name): SPINAL HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5413 BACKLICK RD SUITE E
SPRINGFIELD VA
22151-3915
US

IV. Provider business mailing address

5413 BACKLICK RD SUITE E
SPRINGFIELD VA
22151-3915
US

V. Phone/Fax

Practice location:
  • Phone: 703-333-2848
  • Fax: 703-333-2016
Mailing address:
  • Phone: 703-333-2848
  • Fax: 703-333-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104002096
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0104002096
License Number StateVA

VIII. Authorized Official

Name: DR. HOI THANH HUYNH
Title or Position: PRESIDENT
Credential: D.C., FIAMA
Phone: 703-333-2848