Organization
NOVA BACK DOCTOR PPLC
Active
Organization
NOVA BACK DOCTOR PPLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN DALE CRANDALL DC (DOCTOR)
(703) 719-0900
Entity
Organization
Contact information
Practice address
6080 FRANCONIA RD STE B, ALEXANDRIA, VA 22310-4427
(703) 719-0900
Mailing address
6080 FRANCONIA RD STE B, ALEXANDRIA, VA 22310-4427
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
396
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073551685
CHIROPRACTOR
VA
Enumeration date
02/09/2018
Last updated
02/09/2018
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