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General NPI Number Information
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NPI Number | 1629126016
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Entity Type | Organization
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Legal Business Name | CHANTILLY CHIROPRACTIC CENTER PC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3910 CENTREVILLE ROAD SUITE 202
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City | CHANTILLY
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State | VA
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Zip | 20151
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Country | US
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Telephone | 703-378-2698
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Fax | 703-378-1451
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Provider Business Mailing Address
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Address Line | 3910 CENTREVILLE ROAD SUITE 202
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City | CHANTILLY
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State | VA
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Zip | 20151
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Country | US
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Telephone | 703-378-2698
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Fax | 703-378-1451
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Authorized Official
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Title or Position | OWNER DOCTOR
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Name | WILLIAM TODD FISHER
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Credential | BS DC
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Telephone | 703-378-2698
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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 | 0104001706
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License Number State | VA
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Taxonomy #2
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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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