Provider Demographics
NPI:1134214034
Name:MAGGS, KEVIN (DC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:MAGGS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4505
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-1505
Mailing Address - Country:US
Mailing Address - Phone:703-618-1630
Mailing Address - Fax:
Practice Address - Street 1:7400 HERITAGE VILLAGE PLZ
Practice Address - Street 2:SUITE 101
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3308
Practice Address - Country:US
Practice Address - Phone:703-753-5599
Practice Address - Fax:703-753-7599
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV3096AOtherPTAN
VAU63806Medicare UPIN