Healthcare Provider Details

I. General information

NPI: 1255621330
Provider Name (Legal Business Name): AMONTE CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 67TH ST
VIRGINIA BEACH VA
23451-2061
US

IV. Provider business mailing address

3904 WATER OAK LN
VIRGINIA BEACH VA
23452-2736
US

V. Phone/Fax

Practice location:
  • Phone: 757-515-6374
  • Fax:
Mailing address:
  • Phone: 757-515-6374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number0104556883
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104556882
License Number StateVA

VIII. Authorized Official

Name: DR. JENNET K AMONTE
Title or Position: CORPORATE OFFICER
Credential: D.C.
Phone: 757-515-6374