Healthcare Provider Details

I. General information

NPI: 1710023460
Provider Name (Legal Business Name): MOUNTAINVIEW CHIROPRACTIC AND KINESIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 HILL STREET
DANVILLE VT
05828
US

IV. Provider business mailing address

PO BOX 298 32 HILL STREET
DANVILLE VT
05828
US

V. Phone/Fax

Practice location:
  • Phone: 802-684-9707
  • Fax: 802-684-9707
Mailing address:
  • Phone: 802-684-9707
  • Fax: 802-684-9707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0060001116
License Number StateVT

VIII. Authorized Official

Name: DR. JEREMY STE MARIE
Title or Position: OWNER
Credential: DC
Phone: 802-684-9707