Provider Demographics
NPI:1699772418
Name:DIGIORGIO, NATHALIE M (DC)
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:M
Last Name:DIGIORGIO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 NE 24TH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-5206
Mailing Address - Country:US
Mailing Address - Phone:866-632-4476
Mailing Address - Fax:954-943-7708
Practice Address - Street 1:24 NE 24TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-5206
Practice Address - Country:US
Practice Address - Phone:866-632-4476
Practice Address - Fax:954-943-7708
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8071111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381735100Medicaid
70002OtherBCBS
FL70002YMedicare PIN
FL381735100Medicaid