Nova Back Doctor PPLC

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

396 Issued in VA

Legal business name

NOVA BACK DOCTOR PPLC

Practice address

6080 Franconia Rd Ste B
Alexandria, VA 22310-4427

Phone

(703) 719-0900

NPI assigned

Feb 9, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Benjamin Dale Crandall, DC

Title

Doctor

Phone

(703) 719-0900

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518134400000",
    "number": "1013416569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6080 FRANCONIA RD STE B",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223104427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6080 FRANCONIA RD STE B",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223104427",
            "telephone_number": "703-719-0900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVA BACK DOCTOR PPLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-09",
        "last_updated": "2018-02-09",
        "status": "A",
        "authorized_official_last_name": "CRANDALL",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "703-719-0900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "VA",
            "license": "396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTOR",
            "identifier": "1073551685",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Rehabilitation Chiropractor in Alexandria, VA
• Providers in Alexandria, VA by specialty
• Rehabilitation Chiropractor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.