Individual
DR. BRIAN SCOTT MCNICHOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1712 CLUBHOUSE RD, #102, RESTON, VA 20190-4595
(703) 435-8805
Mailing address
1712 CLUBHOUSE RD, #102, RESTON, VA 20190-4595
(703) 435-8805
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
0104001891
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
333984
ANTHEM BCBS VIRGINIA
VA
01
—
3441318-001
CIGNA (PPO) VIRGINIA
VA
01
—
5209702
AETNA PPO VIRGINIA
VA
01
—
F743-0001
CAREFIRST BCBS
VA
Enumeration date
10/25/2006
Last updated
07/08/2007
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