NPIMap

Organization Active NPI

Stephane Provencher LLC

Doing business as Gainesville Holistic Health Center

  • Chiropractor
  • Gainesville, VA
National Provider Identifier
1578960340
Registry record updated Nov 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
0104556839 Issued in VA
Legal business name
STEPHANE PROVENCHER LLC
Doing business as
Gainesville Holistic Health Center
Practice address
8006 Crescent Park Dr
Gainesville, VA 20155-3444
Phone
(571) 248-0695
Fax
(571) 248-0964
NPI assigned
Nov 22, 2014
Last updated
Nov 22, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2014

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

Authorized official

Name
Dr. Stephane Provencher, D.C.NPI 1376729376
Title
Owner
Phone
(571) 248-0695

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 0104556839 VA Primary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 0104559149 VA

Addresses

Primary practice location

8006 Crescent Park Dr
Gainesville, VA 20155-3444

Mailing address

8006 Crescent Park Dr
Gainesville, VA 20155-3444
Phone (571) 248-0695

Other identifiers 1

IdentifierTypeStateIssuer
VVB2500281OtherVAMEDICARE PTAN

Other names 1

  • Gainesville Holistic Health Center Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1416614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416614400000",
    "number": "1578960340",
    "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": "201553444",
            "telephone_number": "571-248-0695",
            "fax_number": "571-248-0964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHANE PROVENCHER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-22",
        "last_updated": "2014-11-22",
        "status": "A",
        "authorized_official_last_name": "PROVENCHER",
        "authorized_official_first_name": "STEPHANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "571-248-0695",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104556839",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104559149",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "VVB2500281",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gainesville Holistic Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gainesville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2014; 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.