Provider Demographics
NPI:1144565185
Name:VIELMA, REGINA (DC)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:
Last Name:VIELMA
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 1:401 DIVIDEND DR STE F
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1939
Mailing Address - Country:US
Mailing Address - Phone:949-798-9840
Mailing Address - Fax:
Practice Address - Street 1:401 DIVIDEND DR STE F
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1939
Practice Address - Country:US
Practice Address - Phone:949-798-9840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor