Healthcare Provider Details

I. General information

NPI: 1336050426
Provider Name (Legal Business Name): NOVA SPINE AND SPORTS REHAB CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8321 OLD COURTHOUSE RD STE 204
VIENNA VA
22182-3817
US

IV. Provider business mailing address

8321 OLD COURTHOUSE RD STE 204
VIENNA VA
22182-3817
US

V. Phone/Fax

Practice location:
  • Phone: 703-942-8828
  • Fax: 703-942-8829
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: DOUGLAS GOLD
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 703-942-8828