Provider Demographics
NPI:1104889161
Name:LOVAGLIO, ROSA SUSANA (DC)
Entity type:Individual
Prefix:DR
First Name:ROSA
Middle Name:SUSANA
Last Name:LOVAGLIO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 LAFAYETTE CENTER DR
Mailing Address - Street 2:STE 1900
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1260
Mailing Address - Country:US
Mailing Address - Phone:703-327-9773
Mailing Address - Fax:703-378-2241
Practice Address - Street 1:4080 LAFAYETTE CENTER DR
Practice Address - Street 2:SUITE 170
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1218
Practice Address - Country:US
Practice Address - Phone:703-327-9773
Practice Address - Fax:703-327-8315
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007753S27Medicare ID - Type Unspecified
VAV05562Medicare UPIN