Provider Demographics
NPI:1124228937
Name:VIGOR, JOHN CARY III (LAC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CARY
Last Name:VIGOR
Suffix:III
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8120 PENN AVE S
Mailing Address - Street 2:SUITE #559
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-1358
Mailing Address - Country:US
Mailing Address - Phone:612-986-4372
Mailing Address - Fax:
Practice Address - Street 1:8120 PENN AVE S
Practice Address - Street 2:SUITE #559
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1358
Practice Address - Country:US
Practice Address - Phone:612-986-4372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1386171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist