=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033296264
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARC H. FELDMAN, D.C., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 08/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2106 GALLOWS RD SUITE E
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22182-3961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-821-3001
-----------------------------------------------------
Fax | 703-821-2901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2106 GALLOWS RD SUITE E
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22182-3961
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-821-3001
-----------------------------------------------------
Fax | 703-821-2901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARC HAROLD FELDMAN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 703-821-3001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 740
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------