Provider Demographics
NPI:1447521513
Name:RESTON CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:RESTON CHIROPRACTIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-801-5561
Mailing Address - Street 1:11715 BOWMAN GREEN DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3507
Mailing Address - Country:US
Mailing Address - Phone:703-689-2300
Mailing Address - Fax:
Practice Address - Street 1:11715 BOWMAN GREEN DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3507
Practice Address - Country:US
Practice Address - Phone:703-689-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-22
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104 555576261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center