MEDICARE: DR. KENNETH ARTHUR DEGIORGIO DC

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	4400151	OTHER	VA	UNITEDHEALTHCARE PROVIDER
3	102595	OTHER	VA	ANTHEM PROVIDER NUMBER
4	5698700	OTHER	VA	AETNA PROVIDER NUMBER

General Provider Information

NPI Number	:	1457413106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH ARTHUR DEGIORGIO DC

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/08/2007

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