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General NPI Number Information
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NPI Number | 1174701114
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Entity Type | Organization
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Legal Business Name | VIRGINIA COMMONWEALTH CHIROPRACTIC
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Dates
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Enumeration Date | 02/01/2008
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Last Update Date | 04/02/2008
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Provider Practice Location Address
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Address Line | 7297 LEE HWY SUITE H
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City | FALLS CHURCH
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State | VA
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Zip | 22042
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Country | US
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Telephone | 703-533-1201
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Fax | 703-533-1203
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Provider Business Mailing Address
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Address Line | 7297H LEE HWY
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City | FALLS CHURCH
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State | VA
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Zip | 22042
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Country | US
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Telephone | 703-533-1201
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Fax | 703-533-1203
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC OWNER
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Name | DR. CONNIE KHANH DO
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Credential | DC
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Telephone | 703-533-1201
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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 | 0104556124
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License Number State | VA
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