MEDICARE: HOWARD CHIROPRACTIC CLINIC

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	0104557054	VA

General Provider Information

NPI Number	:	1457705576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOWARD CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	1980 GALLOWS RD
Second Line	:	SUITE 205
City	:	VIENNA
State	:	VA
Zip	:	22182-3913
Country	:	US
Telephone Number	:	703-442-0800
Fax Number	:	703-442-0808

Provider Business Practice Location Address
First Line	:	1980 GALLOWS RD
Second Line	:	SUITE 205
City	:	VIENNA
State	:	VA
Zip	:	22182-3913
Country	:	US
Telephone Number	:	703-442-0800
Fax Number	:	703-442-0808

Authorized Official
Title or Position	:	OWNER/ CHIROPRACTOR
Name	:	JESSICA HANNAH-QUEEN HOWARD
Credential	:	D.C.
Telephone Number	:	703-442-0800

Provider Enumeration Date	:	04/14/2016
Last Update Date	:	06/27/2016

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