Provider Demographics
NPI:1194804955
Name:FAMILY AND SPORTS CHIROPRACTIC ,INC.
Entity type:Organization
Organization Name:FAMILY AND SPORTS CHIROPRACTIC ,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WETZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-560-4730
Mailing Address - Street 1:7202 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1859
Mailing Address - Country:US
Mailing Address - Phone:703-560-4730
Mailing Address - Fax:703-560-4731
Practice Address - Street 1:7202 ARLINGTON BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1859
Practice Address - Country:US
Practice Address - Phone:703-560-4730
Practice Address - Fax:703-560-4731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA139135OtherANTHEM PIN
VAG01825F01Medicare PIN