Active NPI
Evan Lichtenauer, DC
- Chiropractor
- Fairfax, VA
National Provider Identifier
1295217537
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 0104-557487
- Practice address
- 9649 Fairfax Blvd
Fairfax, VA 22031-2321 - Phone
- (571) 406-4102
- NPI assigned
- Sep 4, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 0104-557487 | VA | Primary |
Addresses
Primary practice location
9649 Fairfax Blvd
Fairfax, VA 22031-2321
Mailing address
9649 Fairfax Blvd
Fairfax, VA 22031-2321
Phone (571) 406-4102
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0104-557487 | VA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536019200000",
"number": "1295217537",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9649 FAIRFAX BLVD",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220312321",
"telephone_number": "571-406-4102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9649 FAIRFAX BLVD",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220312321",
"telephone_number": "571-406-4102"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICHTENAUER",
"first_name": "EVAN",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-09-04",
"last_updated": "2018-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "VA",
"license": "0104-557487",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 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.