Provider Demographics
NPI:1316540669
Name:DREAM CHIROPRACTIC & WELLNESS BOUTIQUE
Entity type:Organization
Organization Name:DREAM CHIROPRACTIC & WELLNESS BOUTIQUE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AKLILU
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MSACN
Authorized Official - Phone:703-518-7936
Mailing Address - Street 1:2121 EISENHOWER AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4688
Mailing Address - Country:US
Mailing Address - Phone:703-518-7936
Mailing Address - Fax:
Practice Address - Street 1:2121 EISENHOWER AVE STE 210
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4688
Practice Address - Country:US
Practice Address - Phone:703-518-7936
Practice Address - Fax:703-684-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty