Healthcare Provider Details

I. General information

NPI: 1528319662
Provider Name (Legal Business Name): VIRGINIA SPORTS CHIROPRACTIC OF WARRENTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

493 BLACKWELL RD SUITE 117
WARRENTON VA
20186-2639
US

IV. Provider business mailing address

331 WALKER DR STE 6
WARRENTON VA
20186-4374
US

V. Phone/Fax

Practice location:
  • Phone: 540-905-7788
  • Fax: 540-905-4955
Mailing address:
  • Phone: 703-753-0974
  • Fax: 703-753-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HOLLY D MORIARTY
Title or Position: PRESIDENT
Credential: DC
Phone: 703-753-0974