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General NPI Number Information
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NPI Number | 1104430446
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Entity Type | Organization
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Legal Business Name | VICTORY HEALTH OF ONEONTA LLC
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Dates
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Enumeration Date | 09/03/2020
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 28252 AL-75
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City | ONEONTA
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State | AL
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Zip | 35121
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Country | US
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Telephone | 205-625-3621
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Fax |
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Provider Business Mailing Address
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Address Line | 1231 GUNTER AVE
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City | GUNTERSVILLE
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State | AL
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Zip | 35976-1841
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Country | US
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Telephone | 256-582-1066
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Fax | 256-582-1053
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Authorized Official
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Title or Position | CEO
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Name | RICHARD BECHERT
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Credential | DC
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Telephone | 256-582-1066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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