Provider Demographics
NPI:1699932103
Name:ROLLING VALLEY CHIROPRACTIC CENTRE, PC
Entity type:Organization
Organization Name:ROLLING VALLEY CHIROPRACTIC CENTRE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:STINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-455-7707
Mailing Address - Street 1:9279 OLD KEENE MILL RD
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-4202
Mailing Address - Country:US
Mailing Address - Phone:703-455-7707
Mailing Address - Fax:703-451-7397
Practice Address - Street 1:9279 OLD KEENE MILL RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-4202
Practice Address - Country:US
Practice Address - Phone:703-455-7707
Practice Address - Fax:703-451-7397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU63777Medicare UPIN
VA830485Medicare PIN