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General NPI Number Information
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NPI Number | 1104160571
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Entity Type | Organization
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Legal Business Name | UPPER CERVICAL CHIROPRACTIC GROUP, PLLC
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Dates
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Enumeration Date | 11/24/2012
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Last Update Date | 11/24/2012
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Provider Practice Location Address
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Address Line | 3313 DUKE ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-4522
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Country | US
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Telephone | 703-823-3704
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Fax |
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Provider Business Mailing Address
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Address Line | 3313 DUKE ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-4522
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT/MEMBER
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Name | JACOB DODDS
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Credential | D.C.
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Telephone | 319-389-9985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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