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General NPI Number Information
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NPI Number | 1336510395
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Entity Type | Organization
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Legal Business Name | RIVERSIDE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 10/15/2015
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Provider Practice Location Address
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Address Line | 205A THE STRAND
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City | ALEXANDRIA
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State | VA
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Zip | 22314-3367
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Country | US
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Telephone | 703-739-0500
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Fax | 866-545-1147
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Provider Business Mailing Address
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Address Line | 205A THE STRAND
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City | ALEXANDRIA
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State | VA
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Zip | 22314-3367
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Country | US
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Telephone | 703-739-0500
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Fax | 866-545-1147
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DR. WALEED MAHMOUD ABUL-HAWA
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Credential | D.C.
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Telephone | 703-739-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 0104001959
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License Number State | VA
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