Provider Demographics
NPI:1043222904
Name:VIGE, MAXIE (DC)
Entity Type:Individual
Prefix:DR
First Name:MAXIE
Middle Name:
Last Name:VIGE
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 1:325 FM 517 RD E
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-8630
Mailing Address - Country:US
Mailing Address - Phone:281-337-7000
Mailing Address - Fax:281-337-7022
Practice Address - Street 1:325 FM 517 RD E
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-8630
Practice Address - Country:US
Practice Address - Phone:281-337-7000
Practice Address - Fax:281-337-7022
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A3720OtherBCBS PIN
TX8A3720OtherBCBS PIN