Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 111N00000X | Chiropractor | | 0104001411 | VIRGINIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 3320837 | OTHER | VIRGINIA | AETNA HMO PROVIDER # |
| 2 | 5226527 | OTHER | VIRGINIA | CCN PROVIDER # |
| 3 | C08971 | MEDICARE ID-TYPE UNSPECIFIED | VIRGINIA | MEDICARE GROUP # |
| 4 | 5558699 | OTHER | VIRGINIA | AETNA NON-HMO PROVIDER # |
| 5 | 1621623 | OTHER | VIRGINIA | FIRST HEALTH PROVIDER ID# |
| 6 | 2054609 | OTHER | VIRGINIA | UNITED HEALTH CARE ID# |
| 7 | 2135574 | OTHER | VIRGINIA | MAMSI PROVIDER ID # |
| 8 | 2135574 | OTHER | VIRGINIA | MDIPA PROVIDER # |
| 9 | 237552 | OTHER | VIRGINIA | ANTHEM PROVIDER ID# |
| 10 | 00V823P71 | MEDICARE ID-TYPE UNSPECIFIED | VIRGINIA | INDIVIDUAL MEDICARE ID # |
| 11 | 2135574 | OTHER | VIRGINIA | ALLIANCE PROVIDER ID# |
| 12 | 1002386 | OTHER | VIRGINIA | ASHN PROVIDER ID # |
| 13 | J153 | OTHER | VIRGINIA | CAREFIRST BCBS PROVIDER # |
| 14 | 2135574 | OTHER | VIRGINIA | OPTIMUM CHOICE PROVIDER # |
| 15 | 1621623 | OTHER | VIRGINIA | MAILHANDLERS PROVIDER # |
| 16 | 109A-PA | OTHER | VIRGINIA | CAREFIRST BCBS PROVIDER # |
