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General NPI Number Information
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NPI Number | 1457319907
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Entity Type | Organization
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Legal Business Name | CLEGG CHIROPRACTIC P C
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 225 LOUDOUN ST SE
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City | LEESBURG
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State | VA
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Zip | 20175-3115
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Country | US
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Telephone | 703-777-8884
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Fax | 703-777-9071
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Provider Business Mailing Address
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Address Line | 225 LOUDOUN ST SE
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City | LEESBURG
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State | VA
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Zip | 20175-3115
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Country | US
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Telephone | 703-777-8884
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Fax | 703-777-9071
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES R. CLEGG
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Credential | D. C.
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Telephone | 703-777-8884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | E-00
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License Number State | VA
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