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General NPI Number Information
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NPI Number | 1932269057
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Entity Type | Organization
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Legal Business Name | FAMILY CHIROPRACTIC CENTER OF LAKE RIDGE
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 04/19/2024
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Provider Practice Location Address
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Address Line | 12801 DARBY BROOK CT STE 102
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2497
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Country | US
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Telephone | 703-497-2020
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Fax | 703-492-6105
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Provider Business Mailing Address
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Address Line | 12801 DARBY BROOK CT STE 102
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2497
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Country | US
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Telephone | 703-497-2020
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Fax | 703-492-6105
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Authorized Official
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Title or Position | DOCTOR PRESIDENT
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Name | DR. ROSS WEINBERG
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Credential | D.C.
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Telephone | 703-497-2020
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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 | 0104000798
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License Number State | VA
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