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General NPI Number Information
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NPI Number | 1720230303
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Entity Type | Organization
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Legal Business Name | AMERICAN HEALTH AND WELLENSS CENTER, P.C.
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Dates
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Enumeration Date | 10/15/2008
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Last Update Date | 10/15/2008
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Provider Practice Location Address
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Address Line | 13300 FRANKLIN FARM RD STE B
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City | HERNDON
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State | VA
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Zip | 20171-4096
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Country | US
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Telephone | 703-787-7463
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Fax |
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Provider Business Mailing Address
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Address Line | 5804 WATERMARK CIR
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City | CENTREVILLE
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State | VA
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Zip | 20120-2952
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Country | US
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Telephone | 540-239-9886
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Fax |
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | DR. KARL GEOFFREY PETRIE
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Credential | D.C., C.S.C.S.
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Telephone | 540-239-9886
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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 | 0104556207
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License Number State | VA
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