Basic Information
| Provider Information | |||||||||
| NPI: | 1528319662 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VIRGINIA SPORTS CHIROPRACTIC OF WARRENTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 331 WALKER DR STE 6 | ||||||||
| Address2: | |||||||||
| City: | WARRENTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201864374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037530974 | ||||||||
| FaxNumber: | 7037539709 | ||||||||
| Practice Location | |||||||||
| Address1: | 493 BLACKWELL RD | ||||||||
| Address2: | SUITE 117 | ||||||||
| City: | WARRENTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201862639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409057788 | ||||||||
| FaxNumber: | 5409054955 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2012 | ||||||||
| LastUpdateDate: | 06/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | MORIARTY | ||||||||
| AuthorizedOfficialFirstName: | HOLLY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7037530974 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
| NPICertificationDate: | 06/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.