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General NPI Number Information
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NPI Number | 1164726923
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Entity Type | Organization
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Legal Business Name | NATURALLY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 01/07/2011
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 556 GARRISONVILLE RD SUITE 205
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City | STAFFORD
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State | VA
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Zip | 22554
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Country | US
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Telephone | 540-720-9355
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2678
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City | STAFFORD
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State | VA
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Zip | 22555-2678
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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 | PRESIDENT
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Name | DR. NYLSA A CORREA
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Credential | D.C.
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Telephone | 540-720-9355
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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 | 0104556105
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License Number State | VA
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