Organization
CHANTILLY WELLNESS GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMILY DEROCCO DC (SECRETARY)
(620) 504-2434
Entity
Organization
Contact information
Practice address
4200A TECHNOLOGY CT, CHANTILLY, VA 20151-1214
(540) 709-1737
(866) 611-3615
Mailing address
4200A TECHNOLOGY CT, CHANTILLY, VA 20151-1214
(540) 709-1737
(866) 611-3615
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
—
—
363LP0200X
Pediatric Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/01/2024
Last updated
04/28/2025
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