Provider Demographics
NPI:1285612663
Name:GIRGENTI, DAVID M (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:GIRGENTI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1574 SUMMERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-7906
Mailing Address - Country:US
Mailing Address - Phone:815-544-5094
Mailing Address - Fax:
Practice Address - Street 1:6080 ELAINE DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-3006
Practice Address - Country:US
Practice Address - Phone:815-398-0880
Practice Address - Fax:814-398-9466
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL696071Medicare ID - Type Unspecified
ILT37942Medicare UPIN