Provider Demographics
NPI:1851445837
Name:CUERVO, DIEGO RICARDO (DC)
Entity Type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:RICARDO
Last Name:CUERVO
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 1:4652 HAYGOOD RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5447
Mailing Address - Country:US
Mailing Address - Phone:757-363-0118
Mailing Address - Fax:757-363-8932
Practice Address - Street 1:4652 HAYGOOD RD
Practice Address - Street 2:SUITE C
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5447
Practice Address - Country:US
Practice Address - Phone:757-363-0118
Practice Address - Fax:757-363-8932
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor