=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467690743
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | T & J CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2009
-----------------------------------------------------
Last Update Date | 01/26/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10680 MAIN ST SUITE 275
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-3810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-539-8822
-----------------------------------------------------
Fax | 703-539-8862
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10680 MAIN ST SUITE 275
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-3810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-539-8822
-----------------------------------------------------
Fax | 703-539-8862
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JONG HEE CHO
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 703-539-8822
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 0104556321
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0104556321
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------