Provider Demographics
NPI:1639104821
Name:PLESKONKO, TERRY MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:MICHAEL
Last Name:PLESKONKO
Suffix:
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 1:2303 N AUGUSTA ST STE B
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2597
Mailing Address - Country:US
Mailing Address - Phone:540-886-0745
Mailing Address - Fax:540-887-8383
Practice Address - Street 1:2303 N AUGUSTA ST
Practice Address - Street 2:STE B
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401
Practice Address - Country:US
Practice Address - Phone:540-886-0745
Practice Address - Fax:540-887-8383
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
A546090770001OtherCIGNA
029026OtherANTHEM
A546090770001OtherCIGNA
U20061Medicare UPIN