MEDICARE: DR. WILFRIED F SANSFAUTE D.C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0104556267	VA

General Provider Information

NPI Number	:	1386768000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILFRIED F SANSFAUTE D.C

Provider Business Mailing Address
First Line	:	1317 S QUINCY ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-4114
Country	:	US
Telephone Number	:	703-879-5144
Fax Number	:	703-879-5860

Provider Business Practice Location Address
First Line	:	4218 KING ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1507
Country	:	US
Telephone Number	:	703-879-5144
Fax Number	:	703-879-5860

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	01/21/2009

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