Provider Demographics
NPI:1336474089
Name:VARGAS, JAMES EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:VARGAS
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 1:124 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1910
Mailing Address - Country:US
Mailing Address - Phone:508-753-0503
Mailing Address - Fax:508-757-1922
Practice Address - Street 1:124 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1910
Practice Address - Country:US
Practice Address - Phone:508-753-0503
Practice Address - Fax:508-757-1922
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor