MEDICARE: ADVANCED SPINAL CARE

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	0104556588	VA

General Provider Information

NPI Number	:	1699186643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED SPINAL CARE

Provider Business Mailing Address
First Line	:	552 FORT EVANS RD
Second Line	:	SUITE 306
City	:	LEESBURG
State	:	VA
Zip	:	20176-3378
Country	:	US
Telephone Number	:	571-258-1352
Fax Number	:	571-258-1354

Provider Business Practice Location Address
First Line	:	552 FORT EVANS RD
Second Line	:	SUITE 306
City	:	LEESBURG
State	:	VA
Zip	:	20176-3378
Country	:	US
Telephone Number	:	571-258-1352
Fax Number	:	571-258-1354

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	RANDOLPH MILLER MICHAUX JR.
Credential	:	D.C
Telephone Number	:	571-258-1352

Provider Enumeration Date	:	05/13/2014
Last Update Date	:	05/13/2014

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Directions to “ADVANCED SPINAL CARE ” Practice Location

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