Provider Demographics
NPI:1962589051
Name:ABSOLUTE CHIROPRACTIC
Entity type:Organization
Organization Name:ABSOLUTE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WALMSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-742-5470
Mailing Address - Street 1:102 ELDEN ST STE 13
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4827
Mailing Address - Country:US
Mailing Address - Phone:703-742-5470
Mailing Address - Fax:703-742-0435
Practice Address - Street 1:102 ELDEN ST STE 13
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4827
Practice Address - Country:US
Practice Address - Phone:703-742-5470
Practice Address - Fax:703-742-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU53478Medicare UPIN
VA586119Medicare ID - Type Unspecified