Provider Demographics
NPI:1104970938
Name:STATMAN, ERICA MS (DCDICCP)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:MS
Last Name:STATMAN
Suffix:
Gender:F
Credentials:DCDICCP
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:MS
Other - Last Name:SCHACHNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DCDICCP
Mailing Address - Street 1:10807 MAIN ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4730
Mailing Address - Country:US
Mailing Address - Phone:703-383-1630
Mailing Address - Fax:703-383-1631
Practice Address - Street 1:10807 MAIN ST
Practice Address - Street 2:SUITE 800
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4730
Practice Address - Country:US
Practice Address - Phone:703-383-1630
Practice Address - Fax:703-383-1631
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA490261Medicare ID - Type UnspecifiedPROVIDER NUMBER