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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