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General NPI Number Information
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NPI Number | 1265873848
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Entity Type | Organization
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Legal Business Name | SHERWOOD HALL CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/11/2013
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Last Update Date | 07/11/2013
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Provider Practice Location Address
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Address Line | 2616 SHERWOOD HALL LN SUITE 406
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3100
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Country | US
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Telephone | 703-780-9505
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Fax | 703-780-9508
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Provider Business Mailing Address
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Address Line | 2616 SHERWOOD HALL LN SUITE 406
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3100
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Country | US
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Telephone | 703-780-9505
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Fax | 703-780-9508
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALBERT MARSHALL LEAVITT JR.
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Credential | D.C.
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Telephone | 703-780-9505
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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 | 0104000968
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License Number State | VA
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