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General NPI Number Information
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NPI Number | 1174725519
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Entity Type | Organization
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Legal Business Name | PRINCESS ONE CHIROPRACTIC PC
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3809 PRINCESS ANNE RD STE 117
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-1900
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Country | US
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Telephone | 757-471-9008
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Fax | 757-965-6256
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Provider Business Mailing Address
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Address Line | 3192 WINTERBERRY LN
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City | VIRGINIA BEACH
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State | VA
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Zip | 23453-5952
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH A DEGIORGIO
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Credential | DC
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Telephone | 757-471-9008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 0104001829
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License Number State | VA
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