Provider Demographics
NPI:1053511709
Name:VEGA, JIMMY (DC)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:
Last Name:VEGA
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 1:1 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17551-9749
Mailing Address - Country:US
Mailing Address - Phone:717-872-2405
Mailing Address - Fax:
Practice Address - Street 1:1 COUNTRY LN
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17551-9749
Practice Address - Country:US
Practice Address - Phone:717-872-2405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-003058L111NX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0100XChiropractic ProvidersChiropractorOccupational Health