| Elemental Wellness and Spine PC | |
|
21430 Cedar Dr Ste 226 Sterling VA 20164-8697 | |
| (703) 444-3870 | |
| Not Available |
| Full Name | Elemental Wellness and Spine PC |
|---|---|
| Speciality | Clinic/Center |
| Location | 21430 Cedar Dr Ste 226, Sterling, Virginia |
| Authorized Official Name and Position | Tony Knapp (OWNER) |
| Authorized Official Contact | 4017431528 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elemental Wellness and Spine PC 21430 Cedar Dr Ste 226 Sterling VA 20164-8697 Ph: (703) 444-3870 | Elemental Wellness and Spine PC 21430 Cedar Dr Ste 226 Sterling VA 20164-8697 Ph: (703) 444-3870 |
| NPI Number | 1235975756 |
|---|---|
| Provider Enumeration Date | 07/03/2024 |
| Last Update Date | 07/03/2024 |
| Certification Date | 07/03/2024 |
| Medicare PECOS PAC ID | 1557802543 |
|---|---|
| Medicare Enrollment ID | O20240918000097 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235975756 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | () | Primary |
| Provider Name | Charmaine Tuck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265096127 PECOS PAC ID: 2062810575 Enrollment ID: I20211014001052 |
| Provider Name | Silvia Yuen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457051997 PECOS PAC ID: 8123523966 Enrollment ID: I20250924000147 |
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