Provider Demographics
NPI:1841459799
Name:PETER M DADDIO DC
Entity type:Organization
Organization Name:PETER M DADDIO DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:DADDIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-338-0005
Mailing Address - Street 1:17337 PICKWICK DR STE B
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-6176
Mailing Address - Country:US
Mailing Address - Phone:540-338-0005
Mailing Address - Fax:540-338-0966
Practice Address - Street 1:17337 PICKWICK DR STE B
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6176
Practice Address - Country:US
Practice Address - Phone:540-338-0005
Practice Address - Fax:540-338-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09487OtherMEDICARE GROUP NUMBER