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General NPI Number Information
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NPI Number | 1649298415
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Entity Type | Organization
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Legal Business Name | SPINE ARTS CENTER
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 12/09/2008
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Provider Practice Location Address
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Address Line | 6120 BRANDON AVE SUITE 203
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City | SPRINGFIELD
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State | VA
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Zip | 22150-2522
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Country | US
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Telephone | 703-644-2222
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Fax | 703-644-2488
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Provider Business Mailing Address
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Address Line | 6120 BRANDON AVE SUITE 203
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City | SPRINGFIELD
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State | VA
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Zip | 22150-2522
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Country | US
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Telephone | 703-644-2222
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Fax | 703-644-2488
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. GARRY T KRAKOS
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Credential | D.C.
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Telephone | 703-644-2222
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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 | 0104555563
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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 | 0104001821
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License Number State | VA
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