Organization Active NPI

Maimonides Chiropractic PC

  • Chiropractor
  • Fairfax, VA
National Provider Identifier
1417276742
Registry record updated Jul 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
0104001952 Issued in VA
Legal business name
MAIMONIDES CHIROPRACTIC PC
Practice address
10807 Main St Ste 800
Fairfax, VA 22030-4730
Phone
(703) 383-1630
Fax
(703) 383-1631
NPI assigned
May 26, 2010
Last updated
Jul 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2022

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

Authorized official

Name
Dr. Erica Ms Statman, D.C. DI. C.C.P.NPI 1104970938
Title
Chiropractor
Phone
(703) 383-1630

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 0104001952 VA Primary

Addresses

Primary practice location

10807 Main St Ste 800
Fairfax, VA 22030-4730

Mailing address

10807 Main St Ste 800
Fairfax, VA 22030-4730
Phone (703) 383-1630

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100616000061 DC Part B Supplier - Clinic/Group Practice 9931239068 Receives reassigned benefits from 1 practitioner
Practice locations: Fairfax, VA

National Provider Directory

National Provider Directory

Locations

10807 Main St
Ste 800
Fairfax, VA 22030
Phone (703) 383-1630

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1274832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658275200000",
    "number": "1417276742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10807 MAIN ST STE 800",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220304730",
            "telephone_number": "703-383-1630",
            "fax_number": "703-383-1631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10807 MAIN ST STE 800",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220304730",
            "telephone_number": "703-383-1630",
            "fax_number": "703-383-1631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIMONIDES CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-26",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A",
        "authorized_official_last_name": "STATMAN",
        "authorized_official_first_name": "ERICA",
        "authorized_official_middle_name": "MS",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "703-383-1630",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C. DI. C.C.P."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104001952",
            "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 Jul 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.