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General NPI Number Information
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NPI Number | 1932289220
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Entity Type | Organization
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Legal Business Name | FAMILY CHIROPRACTIC CENTER OF FAIRFAX INC.
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10831 MAIN ST
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City | FAIRFAX
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State | VA
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Zip | 22030-4701
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Country | US
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Telephone | 703-273-7733
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Fax | 703-385-9693
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Provider Business Mailing Address
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Address Line | 10831 MAIN ST
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City | FAIRFAX
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State | VA
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Zip | 22030-4701
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Country | US
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Telephone | 703-273-7733
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Fax | 703-385-9693
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY ALLEN DENNIS
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Credential | D.C.
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Telephone | 703-273-7733
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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 | 0104000352
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License Number State | VA
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