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General NPI Number Information
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NPI Number | 1518532829
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Entity Type | Organization
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Legal Business Name | NOVA FUNCTIONAL SPORTS CHIROPRACTIC LLC
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Dates
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Enumeration Date | 05/20/2021
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 44645 GUILFORD DR STE 211
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City | ASHBURN
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State | VA
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Zip | 20147-6020
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Country | US
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Telephone | 315-577-2427
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Fax |
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Provider Business Mailing Address
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Address Line | 44645 GUILFORD DR STE 211
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City | ASHBURN
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State | VA
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Zip | 20147-6020
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Country | US
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Telephone | 703-831-7036
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. JANE ELLEN PAVALKIS
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Credential | DC
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Telephone | 315-577-2427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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