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MASTERPEACE CHIROPRACTIC CENTER P.C. NPI 1700079092


NPI Information

NPI: 1700079092
Provider Name: MASTERPEACE CHIROPRACTIC CENTER, P.C.
Classification: Chiropractor - 111N00000X
Entity Type: Organization
Address:
3302 OLD BRIDGE RD
SUITE GH
LAKE RIDGE, VA
ZIP 22192
Phone: (703) 490-4242
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MASTERPEACE CHIROPRACTIC CENTER, P.C. is a chiropractor in Lake Ridge, VA. The provider is a provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. MASTERPEACE CHIROPRACTIC CENTER, P.C. NPI is 1700079092. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3302 OLD BRIDGE RD
SUITE GH
LAKE RIDGE, VA
ZIP 22192-262
Phone: (703) 490-4242
Fax: (703) 491-6370

The provider's authorized official is Gerard J Mannino .
The authorized official title is President and has the following contact phone number (703) 490-4242.

The enumeration date for this NPI number is 8/21/2007 and was last updated on 8/21/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1111N00000XChiropractor0104000675VIRGINIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1T21935MEDICARE UPINVIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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