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General NPI Number Information
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NPI Number | 1730635079
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Entity Type | Organization
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Legal Business Name | COMPLETE SPINAL CARE & REHAB, LLC
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 08/28/2016
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Provider Practice Location Address
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Address Line | 12662 DARBY BROOK COURT
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City | WOODBRIDGE
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State | VA
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Zip | 22192
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Country | US
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Telephone | 571-398-6343
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Fax |
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Provider Business Mailing Address
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Address Line | 12662 DARBY BROOK COURT
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City | WOODBRIDGE
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State | VA
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Zip | 22192
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Country | US
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Telephone | 571-398-6343
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | MONYA TAVAKOLI
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Credential | DC
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Telephone | 571-398-6343
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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 | 0104557229
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License Number State | VA
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