Organization
COMMONWEALTH ALLIANCE
Active
Other names
HealthSource Chiropractic & Progressive Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LATRICE SHANEE JORDAN D.C. (CLINIC DIRECTOR)
(804) 862-2255
Entity
Organization
Contact information
Practice address
34 MEDICAL PARK BLVD STE C, PETERSBURG, VA 23805-9283
(804) 862-2255
(804) 862-1004
Mailing address
34 MEDICAL PARK BLVD STE C, PETERSBURG, VA 23805-9283
(804) 862-2255
(804) 862-1004
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
0104556905
VA
Other
Enumeration date
11/21/2011
Last updated
11/21/2011
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