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General NPI Number Information
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NPI Number | 1326250598
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Entity Type | Organization
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Legal Business Name | MILLENNIUM CHIROPRACTIC PC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 01/16/2008
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Provider Practice Location Address
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Address Line | 5864 MAPLEDALE PLAZA
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City | WOODBRIDGE
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State | VA
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Zip | 22193
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Country | US
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Telephone | 703-680-3332
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Fax |
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Provider Business Mailing Address
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Address Line | 5864 MAPLEDALE PLAZA
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City | WOODBRIDGE
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State | VA
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Zip | 22193
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Country | US
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Telephone | 703-680-3332
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ARTHUR EDWARD MOOSALLY
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Credential | DC
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Telephone | 703-680-3332
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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 | VA0104002071
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0104002071
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License Number State | VA
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