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General NPI Number Information
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NPI Number | 1437620614
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Entity Type | Organization
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Legal Business Name | EASTERN ROOTS WELLNESS, PL C
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 1497 CHAIN BRIDGE RD STE 101
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City | MC LEAN
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State | VA
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Zip | 22101-5728
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Country | US
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Telephone | 571-354-6643
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Fax |
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Provider Business Mailing Address
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Address Line | 11017 BYRD DR
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City | FAIRFAX
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State | VA
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Zip | 22030-5331
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Country | US
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Telephone | 804-955-0156
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF ACUPUNCTURE
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Name | DR. SARAH DAWN FAGGERT
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Credential | DAC, LAC
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Telephone | 713-354-6643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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