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General NPI Number Information
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NPI Number | 1770604464
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Entity Type | Organization
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Legal Business Name | BACK 2 BACK CHIROPRACTIC
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/01/2017
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Provider Practice Location Address
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Address Line | 14029 LEE JACKSON MEMORIAL HWY
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City | CHANTILLY
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State | VA
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Zip | 20151-1601
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Country | US
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Telephone | 703-378-8633
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Fax | 703-378-7388
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Provider Business Mailing Address
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Address Line | 4124 WALNEY ROAD, SUITE N
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City | CHANTILLY
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State | VA
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Zip | 20151-1601
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Country | US
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Telephone | 703-378-8633
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Fax | 703-378-7388
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DR. RICHARD WEISS
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Credential | D.C.
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Telephone | 703-378-8633
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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 | 0104002089
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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 | 0104002083
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License Number State | VA
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