Healthcare Provider Details

I. General information

NPI: 1518455484
Provider Name (Legal Business Name): SCOTT M. PONQUINETTE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 05/02/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BEAVER CASTLE COURT
HAMPTON VA
23666
US

IV. Provider business mailing address

685 TURNBERRY BLVD UNIT 14479
NEWPORT NEWS VA
23608-0219
US

V. Phone/Fax

Practice location:
  • Phone: 888-902-2696
  • Fax:
Mailing address:
  • Phone: 888-902-2696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104557452
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number1518455484
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: