Healthcare Provider Details

I. General information

NPI: 1629006440
Provider Name (Legal Business Name): VICTORIA ST GERMAIN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 CARMEL RD STE 101
CHARLOTTE NC
28226-8281
US

IV. Provider business mailing address

6303 CARMEL RD STE 101
CHARLOTTE NC
28226-8281
US

V. Phone/Fax

Practice location:
  • Phone: 704-541-4747
  • Fax: 704-541-4746
Mailing address:
  • Phone: 704-541-4747
  • Fax: 704-541-4746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2507
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2507
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: