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General NPI Number Information
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NPI Number | 1215008024
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Entity Type | Organization
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Legal Business Name | FIRST CHIROPRACTIC &ACUPUNCTURE
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/08/2011
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Provider Practice Location Address
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Address Line | 14701 LEE HWY SUITE 307
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City | CENTREVILLE
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State | VA
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Zip | 20121-2137
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Country | US
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Telephone | 703-543-4810
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Fax | 703-543-4811
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Provider Business Mailing Address
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Address Line | 14701 LEE HWY SUITE 307
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City | CENTREVILLE
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State | VA
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Zip | 20121-2137
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Country | US
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Telephone | 703-543-4810
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Fax | 703-543-4811
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | LEE SEOB PARK
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Credential | D.C.
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Telephone | 703-543-4810
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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 | 0104556574
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License Number State | VA
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