Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 0104000644 | VA |
N | 111NS0005X | Chiropractic Sports Physician | 0104000644 | VA |
NPI | 1295722940 |
---|---|
Provider Name | Dr. Dennis John Gesualdi |
First Address | Williamsburg, VA 23188-2410 |
Second Address | Williamsburg, VA 23188-2410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 01/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0104000644 | VA STATE LICENSE (01) | VA |