Healthcare Provider Details

I. General information

NPI: 1275806192
Provider Name (Legal Business Name): DOROSKI CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3122 GOLANSKY BLVD SUITE 102
WOODBRIDGE VA
22192-4267
US

IV. Provider business mailing address

3122 GOLANSKY BLVD SUITE 102
WOODBRIDGE VA
22192-4267
US

V. Phone/Fax

Practice location:
  • Phone: 703-730-9588
  • Fax:
Mailing address:
  • Phone: 703-730-9588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number0104001511
License Number StateVA

VIII. Authorized Official

Name: DR. SCOTT DOROSKI
Title or Position: OWNER
Credential: DACNB, DC
Phone: 703-730-9588