Masterpeace Chiropractic Center, P.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

0104000675 Issued in VA

Legal business name

MASTERPEACE CHIROPRACTIC CENTER, P.C.

Practice address

3302 Old Bridge Rd
Suite GH
Lake Ridge, VA 22192-5262

Phone

(703) 490-4242

Fax

(703) 491-6370

NPI assigned

Aug 21, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Gerard J Mannino, D.C.

Title

President

Phone

(703) 490-4242

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

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

{
    "created_epoch": "1187654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187654400000",
    "number": "1700079092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3302 OLD BRIDGE RD",
            "address_2": "SUITE GH",
            "city": "LAKE RIDGE",
            "state": "VA",
            "postal_code": "221925262",
            "telephone_number": "703-490-4242",
            "fax_number": "703-491-6370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3302 OLD BRIDGE RD",
            "address_2": "SUITE GH",
            "city": "LAKE RIDGE",
            "state": "VA",
            "postal_code": "221925262",
            "telephone_number": "703-490-4242",
            "fax_number": "703-491-6370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASTERPEACE CHIROPRACTIC CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-21",
        "last_updated": "2007-08-21",
        "status": "A",
        "authorized_official_last_name": "MANNINO",
        "authorized_official_first_name": "GERARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-490-4242",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104000675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Riken Kumar, MD
• Lawrence R. Muller, DDS, PC
• Alison L Liudahl, AU.D.,C.C.C.-A,F.A.A
• Logan Denise Luke, OTR/L
• Fetnat Faye Masri-Imadi, MD
• May & Hettler, O.D., PLLC
• Lisa Hoang Moser, PT
• Mina T Mostofi, DMD
• Kristina R Murphy, PT, MPT
• Megan Riley Murphy, AUD

• Chiropractor in Lake Ridge, VA
• Providers in Lake Ridge, VA by specialty
• Chiropractor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2007; 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.