Provider Demographics
NPI:1255621330
Name:AMONTE CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:AMONTE CHIROPRACTIC CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNET
Authorized Official - Middle Name:K
Authorized Official - Last Name:AMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-515-6374
Mailing Address - Street 1:3904 WATER OAK LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2736
Mailing Address - Country:US
Mailing Address - Phone:757-515-6374
Mailing Address - Fax:
Practice Address - Street 1:215 67TH ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-2061
Practice Address - Country:US
Practice Address - Phone:757-515-6374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556883111NN1001X
VA0104556882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty