Provider Demographics
NPI:1174701114
Name:VIRGINIA COMMONWEALTH CHIROPRACTIC
Entity type:Organization
Organization Name:VIRGINIA COMMONWEALTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:KHANH
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-533-1201
Mailing Address - Street 1:7297H LEE HWY
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042
Mailing Address - Country:US
Mailing Address - Phone:703-533-1201
Mailing Address - Fax:703-533-1203
Practice Address - Street 1:7297 LEE HWY
Practice Address - Street 2:SUITE H
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042
Practice Address - Country:US
Practice Address - Phone:703-533-1201
Practice Address - Fax:703-533-1203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA COMMONWEALTH CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-01
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01604Medicare PIN