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General NPI Number Information
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NPI Number | 1659557502
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Entity Type | Organization
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Legal Business Name | KIM CHIROPRACTIC CLINIC, P.A.
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 11/25/2009
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Provider Practice Location Address
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Address Line | 13880 BRADDOCK RD STE 207
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City | CENTREVILLE
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State | VA
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Zip | 20121-2463
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Country | US
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Telephone | 703-815-2300
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Fax | 703-815-1313
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Provider Business Mailing Address
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Address Line | 13880 BRADDOCK RD STE 207
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City | CENTREVILLE
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State | VA
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Zip | 20121-2463
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Country | US
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Telephone | 703-815-2300
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Fax | 703-815-1313
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. EUNG KWON KIM
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Credential | D.C.
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Telephone | 703-815-2300
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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 | 0104555864
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License Number State | VA
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