MEDICARE: PRINCESS ONE CHIROPRACTIC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	0104001829	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3651805	OTHER	VA	CIGNA PROVIDER NUMBER
2	1842017	OTHER	VA	UNITEDHEALTHCARE PROVIDER
3	39060	OTHER	VA	OPTIMA PROVIDER #
4	5698700	OTHER	VA	AETNA PROVIDER NUMBER
5	102595	OTHER	VA	ANTHEM PROVIDER NUMBER
6	2442006	OTHER	VA	UNITEDHEALTHCARE GROUP#

General Provider Information

NPI Number	:	1174725519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRINCESS ONE CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	3192 WINTERBERRY LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-5952
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3809 PRINCESS ANNE RD STE 117
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-1900
Country	:	US
Telephone Number	:	757-471-9008
Fax Number	:	757-965-6256

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KENNETH A DEGIORGIO
Credential	:	DC
Telephone Number	:	757-471-9008

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

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Practice Location Address:

3809 PRINCESS ANNE RD
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23456-1900

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Practice Fax:

1508871955 — LAWRENCE I. IWUAMADI
Practice Location Address:

3809 PRINCESS ANNE RD , SUITE 108
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1457413106 — DR. KENNETH ARTHUR DEGIORGIO DC
Practice Location Address:

3809 PRINCESS ANNE RD STE 117
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23456-1900

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Practice Fax: 757-965-6256

1366505182 — BACK N SHAPE SPORTSMED
Practice Location Address:

3809 PRINCESS ANNE RD
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23456-1900

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Practice Fax:

1316156102 — DERRICK M. BROADAWAY, D.D.S., PC
Practice Location Address:

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23456-1900

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Practice Fax:

1891972543 — AMERICARE MEDICAL SUPPLIES & SERVICES INC
Practice Location Address:

3809 PRINCESS ANNE RD , SUITE 108
VIRGINIA BEACH, VA
23456-1900

Practice Phone: 757-470-5661
Practice Fax: 757-470-5662

Directions to “PRINCESS ONE CHIROPRACTIC PC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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