Provider Demographics
NPI:1871587378
Name:FREDERICKSBURG FAMILY CHIROPRACTIC HEALTH CENTER, INC.
Entity type:Organization
Organization Name:FREDERICKSBURG FAMILY CHIROPRACTIC HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WILSON-LESSER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-891-9191
Mailing Address - Street 1:10411 COURTHOUSE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-1798
Mailing Address - Country:US
Mailing Address - Phone:540-891-9191
Mailing Address - Fax:540-891-9225
Practice Address - Street 1:10411 COURTHOUSE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-1798
Practice Address - Country:US
Practice Address - Phone:540-891-9191
Practice Address - Fax:540-891-9225
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREDERICKSBURG FAMILY CHIROPRACTIC HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-12
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA107096OtherANTHEM BC/BS
VA107096OtherANTHEM BC/BS