Olde Towne Wellness LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

0104001801 Issued in VA

Legal business name

OLDE TOWNE WELLNESS LLC

Practice address

515 S Sycamore St
Petersburg, VA 23803-5037

Phone

(804) 733-8377

Fax

(804) 733-8459

NPI assigned

Dec 4, 2006

Last updated

Feb 23, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Thomnas James Hennessey, D.C.

Title

Owner

Phone

(804) 733-8377

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Thomas James Hennessey, D.C.

  • Chiropractor
  • Petersburg, VA
  • NPI 1285792424
  Medicare reassignment
• Glenn Stuart Muller, D.C.

  • Chiropractor
  • Colonial Heights, VA
  • NPI 1447312756
  NPD (past)
• Daniel David Roth, D.C.

  • Chiropractor
  • Williamsburg, VA
  • NPI 1598900573
  NPD (past)

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298419200000",
    "number": "1144388315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 S SYCAMORE ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238035037",
            "telephone_number": "804-733-8377",
            "fax_number": "804-733-8459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 S SYCAMORE ST",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238035037",
            "telephone_number": "804-733-8377",
            "fax_number": "804-733-8459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLDE TOWNE WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2011-02-23",
        "status": "A",
        "authorized_official_last_name": "HENNESSEY",
        "authorized_official_first_name": "THOMNAS",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-733-8377",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104001801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTHERN HEALTH",
            "identifier": "418235",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "191798",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEATH CARE",
            "identifier": "640-504",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Solomon Ogunware, PHARMD
• Olumuyiwa Akinniyi Ojediran, MD
• Eniola Adebayo Okelana, MD, FCCP
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• Old Dominion Adult Day Care
• Olumuyiwa Ojediran, M.D P.C
• On Time Quality Care Management ,LLC
• Nina Thi Ong-Pham, PA
• Open Doors to Redefining Therapeutic and Consulting Services LLC
• Optimum in Home Care LLC

• Chiropractor in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Chiropractor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.