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Organization
STEPHANE PROVENCHER LLC
Active
Organization
STEPHANE PROVENCHER LLC
Active
Other names
Gainesville Holistic Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANE PROVENCHER D.C. (OWNER)
(571) 248-0695
Entity
Organization
Contact information
Practice address
8006 CRESCENT PARK DR, GAINESVILLE, VA 20155-3444
(571) 248-0695
(571) 248-0964
Mailing address
8006 CRESCENT PARK DR, GAINESVILLE, VA 20155-3444
(571) 248-0695
(571) 248-0964
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0104556839
VA
111N00000X
Chiropractor
0104559149
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VVB2500281
MEDICARE PTAN
VA
Enumeration date
11/22/2014
Last updated
11/22/2014
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