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General NPI Number Information
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NPI Number | 1750654497
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Entity Type | Organization
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Legal Business Name | RECHARGE WELLNESS
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 19945 RIVERSIDE COMMONS PLZ STE 100
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City | ASHBURN
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State | VA
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Zip | 20147-5146
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Country | US
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Telephone | 703-481-4400
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Fax | 703-935-0430
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Provider Business Mailing Address
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Address Line | 18328 BUCCANEER TER
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City | LEESBURG
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State | VA
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Zip | 20176-8474
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Country | US
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Telephone | 703-481-4400
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Fax | 703-935-0430
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRUCE SHORT
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Credential | DC
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Telephone | 703-481-4400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 0104555886
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License Number State | VA
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