Healthcare Provider Details

I. General information

NPI: 1104430446
Provider Name (Legal Business Name): VICTORY HEALTH OF ONEONTA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/03/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28252 AL-75
ONEONTA AL
35121
US

IV. Provider business mailing address

1231 GUNTER AVE
GUNTERSVILLE AL
35976-1841
US

V. Phone/Fax

Practice location:
  • Phone: 205-625-3621
  • Fax:
Mailing address:
  • Phone: 256-582-1066
  • Fax: 256-582-1053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RICHARD BECHERT
Title or Position: CEO
Credential: DC
Phone: 256-582-1066