Provider Demographics
NPI:1063867844
Name:SPORTS CARE ACUPUNCTURE CLINIC, LLC
Entity type:Organization
Organization Name:SPORTS CARE ACUPUNCTURE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-859-1102
Mailing Address - Street 1:7535 LITTLE RIVER TPKE STE 103A
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2983
Mailing Address - Country:US
Mailing Address - Phone:703-859-1102
Mailing Address - Fax:
Practice Address - Street 1:7535 LITTLE RIVER TNPK #103A
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:703-859-1102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty