Provider Demographics
NPI:1588941207
Name:DEROCCO, EMILY (DC)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:DEROCCO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:DELKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4200B TECHNOLOGY CT
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1214
Mailing Address - Country:US
Mailing Address - Phone:620-504-2434
Mailing Address - Fax:
Practice Address - Street 1:4200B TECHNOLOGY CT
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1214
Practice Address - Country:US
Practice Address - Phone:620-504-2434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557276111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor