Provider Demographics
NPI:1972043263
Name:OSTOVAR CHIROPRACTIC
Entity type:Organization
Organization Name:OSTOVAR CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:571-212-9981
Mailing Address - Street 1:1270 BOND ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-3533
Mailing Address - Country:US
Mailing Address - Phone:571-212-9981
Mailing Address - Fax:
Practice Address - Street 1:1270 BOND ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3533
Practice Address - Country:US
Practice Address - Phone:571-212-9981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty