Provider Demographics
NPI:1699906297
Name:OLIVER CHIROPRACTIC ACUPUNCTURE AND PHYSICAL THERAPY
Entity type:Organization
Organization Name:OLIVER CHIROPRACTIC ACUPUNCTURE AND PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIC
Authorized Official - Middle Name:T
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-904-8528
Mailing Address - Street 1:208 ELDEN ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4877
Mailing Address - Country:US
Mailing Address - Phone:703-904-8528
Mailing Address - Fax:703-904-8529
Practice Address - Street 1:208 ELDEN ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4877
Practice Address - Country:US
Practice Address - Phone:703-904-8528
Practice Address - Fax:703-904-8529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001903305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization