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General NPI Number Information
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NPI Number | 1699186643
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Entity Type | Organization
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Legal Business Name | ADVANCED SPINAL CARE
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 552 FORT EVANS RD SUITE 306
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City | LEESBURG
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State | VA
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Zip | 20176-3378
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Country | US
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Telephone | 571-258-1352
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Fax | 571-258-1354
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Provider Business Mailing Address
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Address Line | 552 FORT EVANS RD SUITE 306
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City | LEESBURG
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State | VA
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Zip | 20176-3378
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Country | US
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Telephone | 571-258-1352
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Fax | 571-258-1354
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | RANDOLPH MILLER MICHAUX JR.
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Credential | D.C
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Telephone | 571-258-1352
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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 | 0104556588
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License Number State | VA
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