COMMONWEALTH ALLIANCE (NPI# 1669749529) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669749529 |
| Entity Type | Organization |
| Organization Name | COMMONWEALTH ALLIANCE |
| Other Organization Name | HEALTHSOURCE CHIROPRACTIC & PROGRESSIVE REHAB |
| Practice Address |
34 Medical Park Blvd Ste C Petersburg VA 23805-9283 |
| Practice Telephone | 8048622255 |
| Practice Fax Number | 8048621004 |
| Mailing Telephone | 8048622255 |
| Mailing Fax Number | 8048621004 |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2011-11-21 |
| Authorized Official Name | DR. LATRICE SHANEE JORDAN (CLINIC DIRECTOR) |
| Authorized Official Telephone | 8048622255 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 0104556905 | VA | Chiropractic Providers |
| Other Name | Type Code |
|---|---|
| HealthSource Chiropractic & Progressive Rehab | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | COMMONWEALTH ALLIANCE LLC | 95 Sw 130th Ave, Beaverton, OR 97005 |
| Massachusetts Corporations | COMMONWEALTH ALLIANCE, INC. | 65 James St., Worcester, MA 01603 |
| Street Address |
34 MEDICAL PARK BLVD STE C |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805-9283 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| Find all providers in zip 23805 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639318173 | Petersburg Spine & Sport Inc | Chiropractor | 115 E Douglas Ave, Petersburg, IL 62675-1558 | 2009-02-06 |
| 1114164498 | Michael Gensler | Chiropractor | 110 E. Sheridan Rd, Petersburg, IL 62675-1340 | 2009-01-08 |
| 1659555399 | Shawn Edward Harper | Chiropractor | 320 S Sycamore St, Petersburg, VA 23803-5041 | 2007-12-17 |
| 1255477410 | Rodney L Anderson | Chiropractor | 103 Fram St, Petersburg, AK 99833 | 2007-01-29 |
| 1285792424 | Thomas James Hennessey | Chiropractor | 515 S Sycamore St, Petersburg, VA 23803-5037 | 2006-12-04 |
| 1346253572 | Veronica Lee Dombroski-speaks | Chiropractor | 13936 State Highway 97, Petersburg, IL 62675-6018 | 2006-08-15 |
| 1639159163 | Paul Eric Tschetschot | Chiropractor | 34 Medical Park Blvd, Suite C, Petersburg, VA 23805-9283 | 2006-01-19 |
| 1811385180 | John Charles Curry | Chiropractor | 13936 State Highway 97, Petersburg, IL 62675-6018 | 2015-01-08 |
| 1144388315 | Olde Towne Wellness LLC | Chiropractor | 515 S Sycamore St, Petersburg, VA 23803-5037 | 2006-12-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801494950 | Advanced Chiropractic & Sports Rehabilitation | Chiropractor | 22611 Markey Ct Ste 105, Sterling, VA 20166-6925 | 2020-10-12 |
| 1588261960 | Jacob Chernichky | Chiropractor | 1585 Roanoke Rd, Daleville, VA 24083-2914 | 2020-10-08 |
| 1740887421 | Robyn Victoria Kirby | Chiropractor | 1762 Tyler Rd, Christiansburg, VA 24073-6154 | 2020-10-05 |
| 1053928820 | Movement Methods Chiropractic | Chiropractor | 1276 N Wayne St Apt 617, Arlington, VA 22201-5852 | 2020-09-25 |
| 1265047393 | The Adjustment, Pllc | Chiropractor | 10130 Colvin Run Rd Ste C, Great Falls, VA 22066-1839 | 2020-09-15 |
| 1548874043 | Anam Malik | Chiropractor | 610 Truman Cir Sw, Vienna, VA 22180-6422 | 2020-09-02 |
| 1861006322 | Amato Chiropractic and Rehabilitation Clinic Waynesboro PC | Chiropractor | 2556 Jefferson Hwy Ste 104, Waynesboro, VA 22980-6555 | 2020-09-02 |
| 1114539038 | Jamie Paquette | Chiropractor | 4808 Courthouse St Ste 202, Williamsburg, VA 23188-2684 | 2020-08-21 |
| 1386254084 | Jamie L Sullivan | Chiropractor | 4532 Bonney Rd Ste D, Virginia Beach, VA 23462-3870 | 2020-08-06 |
| 1427674233 | Merrifield Family Chiropractic LLC | Chiropractor | 2750 Prosperity Ave Ste 120, Fairfax, VA 22031-4336 | 2020-06-18 |
| Find all providers with the same taxonomy | ||||
| City | PETERSBURG |
| Zip Code | 23805 |
Please comment or provide details below to improve the information on COMMONWEALTH ALLIANCE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.