NPIMap

Organization Active NPI

Sport and Wellness Chiropractic

  • Chiropractor
  • Annandale, VA
National Provider Identifier
1124320163
Registry record updated Nov 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
0104556853 Issued in VA
Legal business name
SPORT AND WELLNESS CHIROPRACTIC
Practice address
5105 Backlick Rd
Suite a
Annandale, VA 22003-6005
Phone
(703) 642-8685
NPI assigned
Nov 24, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2010

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

Authorized official

Name
Dr. John Dandelski, D.C.
Title
Owner
Phone
(703) 829-7226

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 0104556853 VA Primary

Addresses

Primary practice location

5105 Backlick Rd
Suite a
Annandale, VA 22003-6005

Mailing address

5105A Backlick Rd
Suite a
Annandale, VA 22003-6005
Phone (703) 642-8685

National Provider Directory

National Provider Directory
Tax ID family
Sport and Wellness Chiropractic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5105A Backlick Rd
Ste A
Annandale, VA 22003

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1290556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290556800000",
    "number": "1124320163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5105A BACKLICK RD",
            "address_2": "SUITE A",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220036005",
            "telephone_number": "703-642-8685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5105 BACKLICK RD",
            "address_2": "SUITE A",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220036005",
            "telephone_number": "703-642-8685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORT AND WELLNESS CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-24",
        "last_updated": "2010-11-24",
        "status": "A",
        "authorized_official_last_name": "DANDELSKI",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-829-7226",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104556853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Annandale, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2010; 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.