Provider Demographics
NPI:1295722940
Name:GESUALDI, DENNIS JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JOHN
Last Name:GESUALDI
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 1:3204 IRONBOUND ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2410
Mailing Address - Country:US
Mailing Address - Phone:757-565-6464
Mailing Address - Fax:757-565-7714
Practice Address - Street 1:3204-A IRONBOUND RD.
Practice Address - Street 2:SUITE A
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2410
Practice Address - Country:US
Practice Address - Phone:757-565-6464
Practice Address - Fax:757-565-7714
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000644111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104000644OtherVA STATE LICENSE