Vitasource Chiropractic & Rehabilitation LLC

Primary specialty

Occupational Health ChiropractorTaxonomy code 111NX0100X

License

DC010306 Issued in PA

Legal business name

VITASOURCE CHIROPRACTIC & REHABILITATION LLC

Practice address

1831 W Cheltenham Ave
Elkins Park, PA 19027-1049

Phone

(215) 276-2250

Fax

(215) 276-2110

NPI assigned

Jul 5, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jean Harold Fontaine, D.C.

Title

Doctor of Chiropractic

Phone

(215) 276-2250

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372982400000",
    "number": "1003257031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1831 W CHELTENHAM AVE",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190271049",
            "telephone_number": "215-276-2250",
            "fax_number": "215-276-2110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1831 W CHELTENHAM AVE",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190271049",
            "telephone_number": "215-276-2250",
            "fax_number": "215-276-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITASOURCE CHIROPRACTIC & REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-05",
        "last_updated": "2013-07-05",
        "status": "A",
        "authorized_official_last_name": "FONTAINE",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "HAROLD",
        "authorized_official_title_or_position": "DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "215-276-2250",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NX0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Occupational Health",
            "state": "PA",
            "license": "DC010306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Health Chiropractor in Elkins Park, PA
• Providers in Elkins Park, PA by specialty
• Occupational Health Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.