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General NPI Number Information
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NPI Number | 1700170024
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Entity Type | Organization
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Legal Business Name | SOUTH RIDING SPINE AND THERAPY
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Dates
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Enumeration Date | 06/03/2011
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Last Update Date | 06/03/2011
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Provider Practice Location Address
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Address Line | 43130 AMBERWOOD PLZ SUITE 130
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City | SOUTH RIDING
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State | VA
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Zip | 20152-4105
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Country | US
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Telephone | 703-541-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 43130 AMBERWOOD PLZ SUITE 130
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City | SOUTH RIDING
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State | VA
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Zip | 20152-4105
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Country | US
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Telephone | 703-541-7111
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. DAVID SCHLEIFER
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Credential | DC
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Telephone | 703-541-7111
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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 | 0104001121
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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 | 0104000685
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License Number State | VA
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