Provider Demographics
NPI:1366613044
Name:DOROTHY A. FENSTERER, D.C., P.C.
Entity type:Organization
Organization Name:DOROTHY A. FENSTERER, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FENSTERER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-575-6470
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-0247
Mailing Address - Country:US
Mailing Address - Phone:434-575-6470
Mailing Address - Fax:434-575-6471
Practice Address - Street 1:103 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-4623
Practice Address - Country:US
Practice Address - Phone:434-575-6470
Practice Address - Fax:434-575-6471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA251748OtherANTHEM
VA89-1404-4Medicaid
VAU60475Medicare UPIN
VA89-1404-4Medicaid