The Active Chiropractic Clinic

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

0104556043 Issued in VA

Legal business name

THE ACTIVE CHIROPRACTIC CLINIC

Practice address

5864 Mapledale PLZ
Woodbridge, VA 22193-4535

Phone

(703) 680-3332

Fax

(703) 680-1365

NPI assigned

Mar 22, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Gregory Scott Petruzzi, D.C.NPI 1407971245

Title

Owner

Phone

(703) 680-3332

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Gregory Scott Petruzzi, D.C.

  • Chiropractor
  • Woodbridge, VA
  • NPI 1407971245
  NPD (past) Authorized official

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174649602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5864 MAPLEDALE PLZ",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221934535",
            "telephone_number": "703-680-3332",
            "fax_number": "703-680-1365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5864 MAPLEDALE PLZ",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221934535",
            "telephone_number": "703-680-3332",
            "fax_number": "703-680-1365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE ACTIVE CHIROPRACTIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETRUZZI",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-680-3332",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104556043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Chiropractor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.