Healthcare Provider Details

I. General information

NPI: 1932388717
Provider Name (Legal Business Name): HUTTON CHIROPRACTIC HEALTH CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 11/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 ROLLING RD STE 304
SPRINGFIELD VA
22152-1521
US

IV. Provider business mailing address

6116 ROLLING RD STE 304
SPRINGFIELD VA
22152-1521
US

V. Phone/Fax

Practice location:
  • Phone: 703-644-9311
  • Fax: 703-644-3907
Mailing address:
  • Phone: 703-644-9311
  • Fax: 703-644-3907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556224
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556122
License Number StateVA

VIII. Authorized Official

Name: DR. PETER VICTOR BOYER
Title or Position: OWNER
Credential: D.C.
Phone: 703-644-9311