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General NPI Number Information
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NPI Number | 1699104091
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH SPINE CARE, LLC
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Dates
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Enumeration Date | 11/06/2013
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Last Update Date | 11/06/2013
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Provider Practice Location Address
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Address Line | 9173 ATLEE RD
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-5606
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Country | US
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Telephone | 804-277-8599
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Fax | 804-730-7015
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Provider Business Mailing Address
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Address Line | 9173 ATLEE RD
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-5606
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Country | US
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Telephone | 804-277-8599
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Fax | 804-730-7015
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. EUGENE C ROSS
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Credential | D.C
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Telephone | 804-277-8599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0104556938
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License Number State | VA
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