Healthcare Provider Details

I. General information

NPI: 1528372885
Provider Name (Legal Business Name): QUINTESSENTIAL CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16021 KAIROS RD SUITE C
SOUTH CHESTERFIELD VA
23834-5205
US

IV. Provider business mailing address

16021 KAIROS RD SUITE C
SOUTH CHESTERFIELD VA
23834-5205
US

V. Phone/Fax

Practice location:
  • Phone: 804-536-6262
  • Fax:
Mailing address:
  • Phone: 804-536-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0104556826
License Number StateVA

VIII. Authorized Official

Name: DR. KATRINA S MAYES
Title or Position: OWNER
Credential: D.C.
Phone: 804-536-6262