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General NPI Number Information
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NPI Number | 1710143854
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH CHIROPRACTIC CENTER, INC.
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 08/11/2008
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Provider Practice Location Address
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Address Line | 3756 SOUTH AMHERST HIGHWAY SUITE 100
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City | MADISON HEIGHTS
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State | VA
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Zip | 24572
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Country | US
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Telephone | 434-929-4999
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Fax | 434-929-4997
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Provider Business Mailing Address
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Address Line | 3756 SOUTH AMHERST HIGHWAY SUITE 100
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City | MADISON HEIGHTS
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State | VA
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Zip | 24572
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Country | US
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Telephone | 434-929-4999
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Fax | 434-929-4997
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOUGLAS R FONTEYNE
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Credential | DC
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Telephone | 434-929-4999
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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 | 0104001637
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License Number State | VA
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