=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538813126
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREDERICKSBURG FAMILY CHIROPRACTIC HEALTH CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2022
-----------------------------------------------------
Last Update Date | 02/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10411 COURTHOUSE RD STE B
-----------------------------------------------------
City | SPOTSYLVANIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22553-1720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-891-9191
-----------------------------------------------------
Fax | 540-891-9225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10411 COURTHOUSE RD STE B
-----------------------------------------------------
City | SPOTSYLVANIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22553-1720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-891-9191
-----------------------------------------------------
Fax | 540-891-9225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRIANA ROSE LINTON
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 540-891-9191
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------