Provider Demographics
NPI:1124246277
Name:CHIROPRACTIC HEALTH CLINIC OF MANASSAS, INC.
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH CLINIC OF MANASSAS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:I
Authorized Official - Last Name:KOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-361-0251
Mailing Address - Street 1:9387 FORESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4701
Mailing Address - Country:US
Mailing Address - Phone:703-361-0251
Mailing Address - Fax:703-361-8853
Practice Address - Street 1:9387 FORESTWOOD LN
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4701
Practice Address - Country:US
Practice Address - Phone:703-361-0251
Practice Address - Fax:703-361-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10686Medicare PIN