Provider Demographics
NPI:1164835922
Name:MANKOOEI CHIROPRACTIC CENTER, INC
Entity type:Organization
Organization Name:MANKOOEI CHIROPRACTIC CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCELA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-644-5900
Mailing Address - Street 1:6800 BACKLICK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-3070
Mailing Address - Country:US
Mailing Address - Phone:703-644-5900
Mailing Address - Fax:703-644-5902
Practice Address - Street 1:6800 BACKLICK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-3070
Practice Address - Country:US
Practice Address - Phone:703-644-5900
Practice Address - Fax:703-644-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104555961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty