Provider Demographics
NPI:1881672467
Name:FENSTERER, DOROTHY A (DC)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:A
Last Name:FENSTERER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1993 HAMILTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-2146
Mailing Address - Country:US
Mailing Address - Phone:434-575-5130
Mailing Address - Fax:434-575-7570
Practice Address - Street 1:1993 HAMILTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-2146
Practice Address - Country:US
Practice Address - Phone:434-575-5130
Practice Address - Fax:434-575-7570
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001067111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA89-1404-4Medicaid
VA251748OtherANTHEM
VAU60475Medicare UPIN
VA350000869Medicare PIN