Provider Demographics
NPI:1912010802
Name:GILTZ, STEPHEN SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:SCOTT
Last Name:GILTZ
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 1:2260 SEASHORE SHOPPES
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1364
Mailing Address - Country:US
Mailing Address - Phone:757-496-3353
Mailing Address - Fax:757-496-9247
Practice Address - Street 1:2260 SEASHORE SHOPPES
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1364
Practice Address - Country:US
Practice Address - Phone:757-496-3353
Practice Address - Fax:757-496-9247
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001359111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC04782OtherMEDICARE PTAN
VAU55351Medicare ID - Type Unspecified