Elemental Wellness And Spine Pc | |
21430 Cedar Dr Ste 226 Sterling VA 20164-8697 | |
(703) 444-3870 | |
Not Available |
Full Name | Elemental Wellness And Spine Pc |
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Speciality | Clinic/Center |
Location | 21430 Cedar Dr Ste 226, Sterling, Virginia |
Authorized Official Name and Position | Tony Knapp (OWNER) |
Authorized Official Contact | 4017431528 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Elemental Wellness And Spine Pc 21430 Cedar Dr Ste 226 Sterling VA 20164-8697 Ph: (703) 444-3870 | Elemental Wellness And Spine Pc 21430 Cedar Dr Ste 226 Sterling VA 20164-8697 Ph: (703) 444-3870 |
NPI Number | 1235975756 |
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Provider Enumeration Date | 07/03/2024 |
Last Update Date | 07/03/2024 |
Medicare PECOS PAC ID | 1557802543 |
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Medicare Enrollment ID | O20240918000097 |
Identifier | Type | State | Issuer |
---|---|---|---|
1235975756 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Provider Name | Charmaine Tuck |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1265096127 PECOS PAC ID: 2062810575 Enrollment ID: I20211014001052 |
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