Provider Demographics
NPI:1346307980
Name:VIRGINIA BEACH HOLISTIC CLINIC PC
Entity Type:Organization
Organization Name:VIRGINIA BEACH HOLISTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DEGIORGIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-498-3044
Mailing Address - Street 1:500 CENTRAL DRIVE
Mailing Address - Street 2:SUITE #114
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454
Mailing Address - Country:US
Mailing Address - Phone:757-498-3044
Mailing Address - Fax:757-498-3288
Practice Address - Street 1:500 CENTRAL DRIVE
Practice Address - Street 2:SUITE #114
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454
Practice Address - Country:US
Practice Address - Phone:757-498-3044
Practice Address - Fax:757-498-3288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104001830Medicare PIN