NPIMap

Organization Active NPI

Wynn Wellness Center LLC

  • Chiropractor
  • Fairfax, VA
National Provider Identifier
1770031916
Registry record updated Sep 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
0104556723 Issued in VA
Legal business name
WYNN WELLNESS CENTER LLC
Practice address
8500 Executive Park Ave
Suite 308
Fairfax, VA 22031-2225
Phone
(703) 810-3311
NPI assigned
Sep 16, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2016

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

Authorized official

Name
Vu H Nguyen, D.C.NPI 1962631739
Title
President
Phone
(703) 810-3311

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 0104556723 VA Primary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 0104557322 VA

Addresses

Primary practice location

8500 Executive Park Ave
Suite 308
Fairfax, VA 22031-2225

Mailing address

8500 Executive Park Ave
Suite 308
Fairfax, VA 22031-2225
Phone (703) 810-3311

Other identifiers 1

IdentifierTypeStateIssuer
149951OtherVAMEDICARE PTAN

Other names 1

  • Executive Park Chiropractic & Acupuncture Doing business as

National Provider Directory

National Provider Directory

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": "1473984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473984000000",
    "number": "1770031916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8500 EXECUTIVE PARK AVE",
            "address_2": "SUITE 308",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312225",
            "telephone_number": "703-810-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8500 EXECUTIVE PARK AVE",
            "address_2": "SUITE 308",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220312225",
            "telephone_number": "703-810-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYNN WELLNESS CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-16",
        "last_updated": "2016-09-16",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "VU",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-810-3311",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104556723",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104557322",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "149951",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Executive Park Chiropractic & Acupuncture",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 16, 2016; 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.