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Organization
WYNN WELLNESS CENTER LLC
Active
Organization
WYNN WELLNESS CENTER LLC
Active
Other names
Executive Park Chiropractic & Acupuncture
Organization subpart
No
Provider details
NPI number
Authorized official
VU H NGUYEN D.C. (PRESIDENT)
(703) 810-3311
Entity
Organization
Contact information
Practice address
8500 EXECUTIVE PARK AVE, SUITE 308, FAIRFAX, VA 22031-2225
(703) 810-3311
Mailing address
8500 EXECUTIVE PARK AVE, SUITE 308, FAIRFAX, VA 22031-2225
(703) 810-3311
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0104556723
VA
111N00000X
Chiropractor
0104557322
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149951
MEDICARE PTAN
VA
Enumeration date
09/16/2016
Last updated
09/16/2016
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