Stephane Provencher, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

0104556839 Issued in VA

Practice address

8006 Crescent Park Dr
Gainesville, VA 20155

Phone

(571) 248-0695

Fax

(571) 248-0964

NPI assigned

Jan 21, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Specialty

Chiropractic

Education

Logan College of Chiropractic, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Stephane Provencher LLC

  • Chiropractor
  • Gainesville, VA
  • NPI 1801300348
  NPD Authorized official
• Stephane Provencher LLC

  • Chiropractor
  • Gainesville, VA
  • NPI 1578960340
  NPD (past) Authorized official
• Atrium Health Services

  • Chiropractor
  • Saint Louis, MO
  • NPI 1396414223
  NPD (past)
• Joseph F. Unger, Jr., D.C., a Professional Corporation

  • Chiropractor
  • Saint Louis, MO
  • NPI 1194917104
  NPD (past)

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

{
    "created_epoch": "1200873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1376729376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8006 CRESCENT PARK DR",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "201553444",
            "telephone_number": "571-248-0695",
            "fax_number": "571-248-0964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8006 CRESCENT PARK DR",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "20155",
            "telephone_number": "571-248-0695",
            "fax_number": "571-248-0964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCHER",
        "first_name": "STEPHANE",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-21",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "2008001511",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104556839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prince William H&R Ops Limited Partnership
• Prince William OBGYN Associates, LTD
• Pristine Healthcare Services, LLC
• PT Solutions LLC
• PT Solutions LLC
• Erika Ptak
• Pure Therapeutic Counseling, PLLC
• Kevin Rabago

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.