Provider Demographics
NPI:1194951277
Name:SOMMERVILLE CHIROPRACTIC & WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:SOMMERVILLE CHIROPRACTIC & WELLNESS CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:DONOFRIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:804-745-8745
Mailing Address - Street 1:11037 HULL STREET RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3254
Mailing Address - Country:US
Mailing Address - Phone:804-745-7822
Mailing Address - Fax:804-523-8022
Practice Address - Street 1:11037 HULL STREET RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3254
Practice Address - Country:US
Practice Address - Phone:804-745-7822
Practice Address - Fax:804-523-8022
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOMMERVILLE CHIROPRACTIC & WELLNESS CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty