Provider Demographics
NPI:1306160536
Name:MANASSAS CHIROPRACTIC NEUROLOGY CENTER, INC
Entity type:Organization
Organization Name:MANASSAS CHIROPRACTIC NEUROLOGY CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DULCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-538-5455
Mailing Address - Street 1:9840 LIBERIA AVE
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5836
Mailing Address - Country:US
Mailing Address - Phone:703-475-6566
Mailing Address - Fax:703-794-9455
Practice Address - Street 1:9840 LIBERIA AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5836
Practice Address - Country:US
Practice Address - Phone:703-475-6566
Practice Address - Fax:703-794-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001349111N00000X
VA0104000784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty