Healthcare Provider Details

I. General information

NPI: 1396035473
Provider Name (Legal Business Name): JENNET K AMONTE D,C,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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 TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number0104556883
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: