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General NPI Number Information
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NPI Number | 1720060650
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Entity Type | Organization
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Legal Business Name | ADVANCED CHIROPRACTIC AND REHABILITATION PC
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 06/16/2020
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Provider Practice Location Address
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Address Line | 14535 JOHN MARSHALL HIGHWAY SUITE 102
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City | GAINESVILLE
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State | VA
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Zip | 20155-3839
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Country | US
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Telephone | 703-753-0974
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Fax | 703-753-9709
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Provider Business Mailing Address
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Address Line | 14535 JOHN MARSHALL HWY STE 104
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City | GAINESVILLE
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State | VA
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Zip | 20155-4024
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Country | US
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Telephone | 703-753-0974
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Fax | 703-753-9709
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Authorized Official
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Title or Position | OWNER
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Name | MRS. HOLLY D MORIARTY
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Credential | DC
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Telephone | 703-675-7179
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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 | 0104556132
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License Number State | VA
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