Provider Demographics
NPI:1023210424
Name:DR. WILLIAM E. DEREGIBUS PC
Entity Type:Organization
Organization Name:DR. WILLIAM E. DEREGIBUS PC
Other - Org Name:FARMVILLE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEREGIBUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:434-392-9807
Mailing Address - Street 1:1414 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-2648
Mailing Address - Country:US
Mailing Address - Phone:434-392-9807
Mailing Address - Fax:434-392-7081
Practice Address - Street 1:1414 W 3RD ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2648
Practice Address - Country:US
Practice Address - Phone:434-392-9807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA015842OtherANTHEM PROVIDER
VA3500002110OtherRAILROAD MEDICAL PROVIDER
VA350000288Medicare ID - Type UnspecifiedMEDICARE PROVIDER