Healthcare Provider Details

I. General information

NPI: 1881672467
Provider Name (Legal Business Name): DOROTHY A. FENSTERER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1993 HAMILTON BLVD SUITE A
SOUTH BOSTON VA
24592-2146
US

IV. Provider business mailing address

1993 HAMILTON BLVD SUITE A
SOUTH BOSTON VA
24592-2146
US

V. Phone/Fax

Practice location:
  • Phone: 434-575-5130
  • Fax: 434-575-7570
Mailing address:
  • Phone: 434-575-5130
  • Fax: 434-575-7570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104001067
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: