Basic Information
| Provider Information | |||||||||
| NPI: | 1851702203 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLE SPORTS CHIROPRACTIC & REHAB, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7371 ATLAS WALK WAY # 270 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201552992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5402424489 | ||||||||
| FaxNumber: | 5402424731 | ||||||||
| Practice Location | |||||||||
| Address1: | 385 GARRISONVILLE RD | ||||||||
| Address2: | SUITE 121 & 211 | ||||||||
| City: | STAFFORD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 225541545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5402424489 | ||||||||
| FaxNumber: | 5402424731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2014 | ||||||||
| LastUpdateDate: | 05/19/2014 | ||||||||
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| AuthorizedOfficialLastName: | COLE | ||||||||
| AuthorizedOfficialFirstName: | JOSHUA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5402738068 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NS0005X | 0104556795 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Sports Physician |
No ID Information.