Provider Demographics
NPI:1528319662
Name:VIRGINIA SPORTS CHIROPRACTIC OF WARRENTON
Entity type:Organization
Organization Name:VIRGINIA SPORTS CHIROPRACTIC OF WARRENTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORIARTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-753-0974
Mailing Address - Street 1:331 WALKER DR STE 6
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-4374
Mailing Address - Country:US
Mailing Address - Phone:703-753-0974
Mailing Address - Fax:703-753-9709
Practice Address - Street 1:493 BLACKWELL RD
Practice Address - Street 2:SUITE 117
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2639
Practice Address - Country:US
Practice Address - Phone:540-905-7788
Practice Address - Fax:540-905-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty