Provider Demographics
NPI:1992712541
Name:ASIMACOPOULOS, VASELES
Entity type:Individual
Prefix:
First Name:VASELES
Middle Name:
Last Name:ASIMACOPOULOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 AMOS LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-7107
Mailing Address - Country:US
Mailing Address - Phone:540-786-4882
Mailing Address - Fax:540-786-4893
Practice Address - Street 1:5705 SALEM RUN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-7119
Practice Address - Country:US
Practice Address - Phone:540-726-4882
Practice Address - Fax:540-786-4893
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104555602OtherVA STATE LICENSE NUMBER
VA00V586A18Medicare PIN
VA0104555602OtherVA STATE LICENSE NUMBER