| |
20955 Professional Plz Ste 320, Ashburn, VA 20147-3405 | |
(571) 918-0795 | |
(571) 918-0808 |
Full Name | |
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Type | Facility |
Speciality | Clinic/center - Multi-specialty |
Location | 20955 Professional Plz Ste 320, Ashburn, Virginia |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1912062985 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | 03422 (Maryland) | Secondary |
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Provider Name | Kraig D Moore |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1790957983 PECOS PAC ID: 4981741063 Enrollment ID: I20100614000282 |
Provider Name | Tara Lynn Urschel |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1932149796 PECOS PAC ID: 8426222795 Enrollment ID: I20220203002078 |
Mailing Address | Practice Location Address |
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20955 Professional Plz Ste 320, Ashburn, VA 20147-3405 Ph: (571) 918-0795 | 20955 Professional Plz Ste 320, Ashburn, VA 20147-3405 Ph: (571) 918-0795 |