=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578720017
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIROCARE PLUS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2008
-----------------------------------------------------
Last Update Date | 01/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3204 IRONBOUND RD SUITE A
-----------------------------------------------------
City | WILLIAMSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23188-2410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-565-6464
-----------------------------------------------------
Fax | 757-565-7714
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3204 IRONBOUND RD SUITE A
-----------------------------------------------------
City | WILLIAMSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23188-2410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-565-6464
-----------------------------------------------------
Fax | 757-565-7714
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF CHIROPRACTIC/DIRECTOR
-----------------------------------------------------
Name | DR. DENNIS JOHN GESUALDI
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 757-565-6464
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 010400644
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 0104000644
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------