| Organization Name: | SPORT & SPINE REHAB OF STERLING |
| NPI Number: | 1164619706 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TAWANDA HACKLEY (MANGER) |
| Mailing Address: | 46440 Benedict Dr Ste 106 Sterling |
| State: | VA US |
| Postal Code: | 201646602 |
| Phone Number: | 2407660300 |
| Fax Number: | 2407660304 |
| NPI Enumeration Date: | 09/27/2007 |
| NPI Last Update Date: | 09/27/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 111N00000X |
| License Number: | 0104556529 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Chiropractic Providers |
| Taxonomy Classification: | Chiropractor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |