Provider Demographics
NPI:1215084306
Name:COMMONWEALTH CHIROPRACTIC CENTER OF RESTON, P.C.
Entity type:Organization
Organization Name:COMMONWEALTH CHIROPRACTIC CENTER OF RESTON, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:STEPHAN
Authorized Official - Last Name:KULIK
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:703-742-7856
Mailing Address - Street 1:11495 SUNSET HILLS RD STE 240
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5257
Mailing Address - Country:US
Mailing Address - Phone:703-742-7856
Mailing Address - Fax:703-742-4064
Practice Address - Street 1:11495 SUNSET HILLS RD STE 240
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5257
Practice Address - Country:US
Practice Address - Phone:703-742-7856
Practice Address - Fax:703-742-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA038341Medicare ID - Type UnspecifiedMEDICARE CLINIC NUMBER