Provider Demographics
NPI:1992814727
Name:POSITIVELY CHIROPRACTIC AND DYNAMIC KINESIOLOGY
Entity type:Organization
Organization Name:POSITIVELY CHIROPRACTIC AND DYNAMIC KINESIOLOGY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:COUTINHO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-642-8685
Mailing Address - Street 1:5105 BACKLICK RD # A
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6005
Mailing Address - Country:US
Mailing Address - Phone:703-642-8685
Mailing Address - Fax:703-642-1507
Practice Address - Street 1:5105 BACKLICK RD # A
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6005
Practice Address - Country:US
Practice Address - Phone:703-642-8685
Practice Address - Fax:703-642-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherTAX ID NUMBER