Provider Demographics
NPI:1548860778
Name:ROHAN, PETER (DC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:ROHAN
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 1:6000 PALISADES CIR APT 6404
Mailing Address - Street 2:
Mailing Address - City:MANASSAS PARK
Mailing Address - State:VA
Mailing Address - Zip Code:20111-8076
Mailing Address - Country:US
Mailing Address - Phone:703-626-1239
Mailing Address - Fax:703-421-2822
Practice Address - Street 1:14215E CENTREVILLE SQ
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2301
Practice Address - Country:US
Practice Address - Phone:703-222-3737
Practice Address - Fax:703-421-2822
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA123456111N00000X
VA0104-557696111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty