Provider Demographics
NPI:1659554434
Name:DEGIORGIO, TINA M (DC)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:M
Last Name:DEGIORGIO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CENTRAL DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5236
Mailing Address - Country:US
Mailing Address - Phone:757-498-3044
Mailing Address - Fax:757-498-3288
Practice Address - Street 1:500 CENTRAL DR
Practice Address - Street 2:SUITE 114
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5236
Practice Address - Country:US
Practice Address - Phone:757-498-3044
Practice Address - Fax:757-498-3288
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01041830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104001830Medicare PIN