Provider Demographics
NPI:1306052766
Name:ALTERNATIVE WELLNESS CLINIC
Entity type:Organization
Organization Name:ALTERNATIVE WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:GAUTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-404-1807
Mailing Address - Street 1:2 PIDGEON HILL DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6145
Mailing Address - Country:US
Mailing Address - Phone:703-404-1807
Mailing Address - Fax:703-404-1827
Practice Address - Street 1:2 PIDGEON HILL DR
Practice Address - Street 2:SUITE 280
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6145
Practice Address - Country:US
Practice Address - Phone:703-404-1807
Practice Address - Fax:703-404-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01014555777111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty