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General NPI Number Information
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NPI Number | 1528319662
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Entity Type | Organization
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Legal Business Name | VIRGINIA SPORTS CHIROPRACTIC OF WARRENTON
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Dates
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Enumeration Date | 09/28/2012
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Last Update Date | 06/16/2020
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Provider Practice Location Address
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Address Line | 493 BLACKWELL RD SUITE 117
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City | WARRENTON
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State | VA
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Zip | 20186-2639
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Country | US
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Telephone | 540-905-7788
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Fax | 540-905-4955
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Provider Business Mailing Address
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Address Line | 331 WALKER DR STE 6
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City | WARRENTON
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State | VA
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Zip | 20186-4374
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Country | US
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Telephone | 703-753-0974
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Fax | 703-753-9709
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Authorized Official
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Title or Position | PRESIDENT
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Name | HOLLY D MORIARTY
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Credential | DC
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Telephone | 703-753-0974
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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 | VA
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