Provider Demographics
NPI:1902911290
Name:NOVA SPINE & INJURY CENTER, INC.
Entity Type:Organization
Organization Name:NOVA SPINE & INJURY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-222-6211
Mailing Address - Street 1:42020 VILLAGE CENTER PLZ
Mailing Address - Street 2:SUITE 120, PMB 177
Mailing Address - City:STONE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-3034
Mailing Address - Country:US
Mailing Address - Phone:703-222-6211
Mailing Address - Fax:703-222-6212
Practice Address - Street 1:4211 FAIRFAX CORNER EAST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-8622
Practice Address - Country:US
Practice Address - Phone:703-222-6211
Practice Address - Fax:703-222-6212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherFEDERAL TAX ID