Provider Demographics
NPI:1124678339
Name:SALT & LIGHT CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:SALT & LIGHT CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:BAHK
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:202-352-3396
Mailing Address - Street 1:485 HARBOR SIDE ST APT 402
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-5458
Mailing Address - Country:US
Mailing Address - Phone:202-352-3396
Mailing Address - Fax:
Practice Address - Street 1:6225 BRANDON AVE STE 175
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2519
Practice Address - Country:US
Practice Address - Phone:202-352-3396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty