Provider Demographics
NPI:1457413106
Name:DEGIORGIO, KENNETH ARTHUR (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ARTHUR
Last Name:DEGIORGIO
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 1:3192 WINTERBERRY LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-5952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3809 PRINCESS ANNE RD STE 117
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-1900
Practice Address - Country:US
Practice Address - Phone:757-471-9008
Practice Address - Fax:757-965-6256
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3651805OtherCIGNA PROVIDER NUMBER
VA4400151OtherUNITEDHEALTHCARE PROVIDER
VA102595OtherANTHEM PROVIDER NUMBER
VA5698700OtherAETNA PROVIDER NUMBER
VA3651805OtherCIGNA PROVIDER NUMBER
VA4400151OtherUNITEDHEALTHCARE PROVIDER