SPORT AND SPINE REHAB OF FAIRFAX (NPI# 1174735856) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174735856 |
| Entity Type | Organization |
| Organization Name | SPORT AND SPINE REHAB OF FAIRFAX |
| Practice Address |
10807 Main Street Fairfax VA 22303 |
| Mailing Address |
11418 Livingston Road Ft. Washington MD 20744 |
| Practice Telephone | 7038902222 |
| Mailing Telephone | 2407660300 |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. JAY GREENSTEIN (CEO) |
| Authorized Official Telephone | 2407660300 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 111N00000X | Chiropractor | Chiropractic Providers | ||
| X | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AETNA HMO | 1066011 | 01 | |
| ALLIANCE | 2159023 | 01 | |
| AETNA PPO | 07950876 | 01 | |
| BCBS OF NCA | K218 | 01 | |
| PHCS | 20994125 | 01 | |
| ANTHEM | 196849 | 01 | |
| MAMSI MDIPA OPTIMUM CHOIC | 2159023 | 01 | |
| ASHN CIGNA HMO | 1066011 | 01 | |
| CIGNA PPO | 698870 | 01 |
| Street Address |
10807 MAIN STREET |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689121709 | Mid Atlantic Medical Management, LLC | Internal Medicine | 5904 Old Richmond Highway, Suite 515, Alexandria, VA 22303 | 2016-09-07 |
| 1932562311 | Alexandria Pain & Rehabilitation Center,llc | Chiropractor | 5904 Old Richmond Hwy, Suite 515, Alexandria, VA 22303 | 2016-04-01 |
| 1437570975 | Joel Gregory Goldman | Orthopaedic Surgery | 2047 Blunt Lane, Alexandria, VA 22303 | 2013-12-31 |
| 1154379287 | Arthur Brantz | General Practice | 6020 Richmond Highway, 102, Alexandria, VA 22303 | 2006-05-04 |
| 1093885535 | Advanced Urgent Medical Care, Inc. | Emergency Medicine | 6020 Richmond Highway, Suite 100, Alexandria, VA 22303 | 2006-11-09 |
| 1225699960 | Andrea Rivero | Behavior Technician | 3710 Towanda Rd, Alexandria, VA 22303-1039 | 2019-06-24 |
| 1346435617 | Malgorzata Grzybowska | Contractor | 5701 Evergreen Knoll Ct, Alexandria, VA 22303-1056 | 2007-09-10 |
| 1992176804 | Sunray Occupational Therapy Servicees LLC | Occupational Therapist | 5701 Evergreen Knoll Ct, Alexandria, VA 22303-1056 | 2015-10-18 |
| 1780187757 | Esther's Home LLC | Foster Care Agency | 3302 Campbell Dr, Alexandria, VA 22303-1108 | 2018-03-15 |
| 1568528719 | Vera M. Ando-winstead | Massage Therapist | 3613 Elmwood Dr, Alexandria, VA 22303-1128 | 2006-12-29 |
| Find all providers in zip 22303 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427674233 | Merrifield Family Chiropractic LLC | Chiropractor | 2750 Prosperity Ave Ste 120, Fairfax, VA 22031-4336 | 2020-06-18 |
| 1841858305 | Jerry Cowart IIi | Chiropractor | 8500 Executive Park Ave Ste 300, Fairfax, VA 22031-2228 | 2019-05-30 |
| 1265914246 | Chiropractic Concepts Plc | Chiropractor | 3857 Plaza Dr, Fairfax, VA 22030-2512 | 2018-09-05 |
| 1932681277 | Empower Chiropractic LLC | Chiropractor | 9649 Fairfax Blvd, Fairfax, VA 22031-2321 | 2018-09-04 |
| 1326529843 | Eddie Hyun Kim | Chiropractor | 10340 Democracy Ln Ste 203, Fairfax, VA 22030-2518 | 2018-08-23 |
| 1811408685 | Young Chiropractic and Rehab, LLC | Chiropractor | 10400 Eaton Pl Ste 410, Fairfax, VA 22030-2208 | 2017-10-19 |
| 1417487497 | Robert Tyler Schnitzler | Chiropractor | 3925 Chain Bridge Rd Ste 101, Fairfax, VA 22030-3938 | 2017-06-13 |
| 1548622483 | Robert J Ciprian | Chiropractor | 8550 Arlington Blvd., Suite 325, Fairfax, VA 22031-4647 | 2016-03-21 |
| 1508257890 | Monya Tavakoli | Chiropractor | 9693 Main St Ste C, Fairfax, VA 22031-3771 | 2015-02-09 |
| 1649699109 | Cheon Gyu Park | Chiropractor | 10680 Main St, Suite 275, Fairfax, VA 22030 | 2014-04-14 |
| Find all providers in FAIRFAX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.