Provider Demographics
NPI:1154577278
Name:BASICS FIRST HEALTH SYSTEM
Entity type:Organization
Organization Name:BASICS FIRST HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-777-2532
Mailing Address - Street 1:522 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4112
Mailing Address - Country:US
Mailing Address - Phone:703-777-2532
Mailing Address - Fax:703-777-8002
Practice Address - Street 1:522 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4112
Practice Address - Country:US
Practice Address - Phone:703-777-2532
Practice Address - Fax:703-777-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487836250OtherINDIVIDUAL NPI #
C10920Medicare PIN