Stephane Provencher LLC

NPI #1578960340 in Gainesville, Virginia

Provider Information

NPI Number: 1578960340
Entity Type: Organization
Organization Name: Stephane Provencher LLC
Primary Specialty: Chiropractor
Enumeration Date: Nov 22, 2014
Last Updated: Nov 22, 2014

Practice Location

Address: 8006 CRESCENT PARK DR
City: Gainesville
State: Virginia
ZIP Code: 20155-3444
Phone: (571) 248-0695

Authorized Official

Name: DR. STEPHANE PROVENCHER, D.C.
Title: OWNER
Phone: (571) 248-0695

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Chiropractor	111N00000X	Primary

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