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General NPI Number Information
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NPI Number | 1831591981
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Entity Type | Organization
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Legal Business Name | LOVESPINE CHIROPRACTIC CLINIC II, INC.
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 02/08/2016
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Provider Practice Location Address
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Address Line | 14161 ROBERT PARIS CT SUITE B
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City | CHANTILLY
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State | VA
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Zip | 20151-4238
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Country | US
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Telephone | 703-429-4622
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Fax | 703-429-4623
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Provider Business Mailing Address
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Address Line | 14161 ROBERT PARIS CT SUITE B
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City | CHANTILLY
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State | VA
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Zip | 20151-4238
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Country | US
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Telephone | 703-429-4622
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Fax | 703-429-4623
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. HYUNG HOON LEE
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Credential | D.C.
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Telephone | 703-429-4622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 0104557204
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License Number State | VA
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