Provider Demographics
NPI:1982074670
Name:AMERICAN CHIROPRACTIC CLINIC, PLLC
Entity type:Organization
Organization Name:AMERICAN CHIROPRACTIC CLINIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-368-8800
Mailing Address - Street 1:8424 DORSEY CIR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-8301
Mailing Address - Country:US
Mailing Address - Phone:703-368-8800
Mailing Address - Fax:703-368-1281
Practice Address - Street 1:8224 SPRUCE ST STE 330
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20111-2201
Practice Address - Country:US
Practice Address - Phone:703-368-8000
Practice Address - Fax:703-368-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty