| Provenance Chiropractic Llc | |
|
10120 W Broad St Ste O, Glen Allen, VA 23060-6709 | |
| (804) 214-6194 | |
| Not Available |
| Full Name | Provenance Chiropractic Llc |
|---|---|
| Type | Facility |
| Speciality | Chiropractor |
| Location | 10120 W Broad St Ste O, Glen Allen, Virginia |
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871323956 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | (* (Not Available)) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Provenance Chiropractic Llc 10120 W Broad St Ste O, Glen Allen, VA 23060-6709 Ph: () - | Provenance Chiropractic Llc 10120 W Broad St Ste O, Glen Allen, VA 23060-6709 Ph: (804) 214-6194 |
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