Commonwealth Alliance

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

0104556905 Issued in VA

Legal business name

COMMONWEALTH ALLIANCE

Practice address

34 Medical Park Blvd Ste C
Petersburg, VA 23805-9283

Phone

(804) 862-2255

Fax

(804) 862-1004

NPI assigned

Nov 21, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Latrice Shanee Jordan, D.C.

Title

Clinic Director

Phone

(804) 862-2255

Specialties & licenses 1

Addresses

Other names 1

• HealthSource Chiropractic & Progressive Rehab Doing business as

Locations

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

{
    "created_epoch": "1321833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321833600000",
    "number": "1669749529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 MEDICAL PARK BLVD STE C",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059283",
            "telephone_number": "804-862-2255",
            "fax_number": "804-862-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 MEDICAL PARK BLVD STE C",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059283",
            "telephone_number": "804-862-2255",
            "fax_number": "804-862-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH ALLIANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-21",
        "last_updated": "2011-11-21",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "LATRICE",
        "authorized_official_middle_name": "SHANEE",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "804-862-2255",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "VA",
            "license": "0104556905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthSource Chiropractic & Progressive Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Valentina R Cole, MAS
• Jerome Eric Coleman
• Collaboration Effort Inc.
• Steven Colpo
• Sarah Combs, PTA
• Commonwealth Behavioral Care Services LLC
• Commonwealth Care Services LLC
• Commonwealth Day Support
• Commonwealth Day Support Inc
• Commonwealth Foot and Ankle, Inc.

• 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 Nov 21, 2011; 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.