=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457516718
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KLINE CHIROPRACTIC & WELLNESS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2008
-----------------------------------------------------
Last Update Date | 07/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4004 GENESEE PL SUITE 213
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22192-8303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-680-4344
-----------------------------------------------------
Fax | 703-680-0440
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4004 GENESEE PL SUITE 213
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22192-8303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-680-4344
-----------------------------------------------------
Fax | 703-680-0440
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ERIN WELLS KLINE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 703-680-4344
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0104556219
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------