Provider Demographics
NPI:1467481903
Name:MAGGIO, JAMES JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:MAGGIO
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1188
Mailing Address - Country:US
Mailing Address - Phone:757-473-9900
Mailing Address - Fax:757-499-3605
Practice Address - Street 1:525 S INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1188
Practice Address - Country:US
Practice Address - Phone:757-473-9900
Practice Address - Fax:757-499-3605
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001522111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA188126OtherANTHEM
VA188126OtherANTHEM
VA188126OtherANTHEM
VAU59709Medicare UPIN