Organization
OLDE TOWNE WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMNAS JAMES HENNESSEY D.C. (OWNER)
(804) 733-8377
Entity
Organization
Contact information
Practice address
515 S SYCAMORE ST, PETERSBURG, VA 23803-5037
(804) 733-8377
(804) 733-8459
Mailing address
515 S SYCAMORE ST, PETERSBURG, VA 23803-5037
(804) 733-8377
(804) 733-8459
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0104001801
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
191798
ANTHEM
VA
01
—
418235
SOUTHERN HEALTH
VA
01
—
640-504
UNITED HEATH CARE
VA
Enumeration date
12/04/2006
Last updated
02/23/2011
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