Healthcare Provider Details

I. General information

NPI: 1003443359
Provider Name (Legal Business Name): HENRY A MCCLEARY DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241C TACKETTS MILL DR
WOODBRIDGE VA
22192-3028
US

IV. Provider business mailing address

2241C TACKETTS MILL DR
WOODBRIDGE VA
22192-3028
US

V. Phone/Fax

Practice location:
  • Phone: 703-463-4644
  • Fax: 855-552-3776
Mailing address:
  • Phone: 703-463-4644
  • Fax: 855-552-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HENRY A MCCLEARY
Title or Position: OWNER
Credential: DC
Phone: 703-463-4644