Provider Demographics
NPI:1376765636
Name:VIGH, JANICE (DOM)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:VIGH
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 PRISM DR
Mailing Address - Street 2:
Mailing Address - City:LESLIE
Mailing Address - State:AR
Mailing Address - Zip Code:72645-6714
Mailing Address - Country:US
Mailing Address - Phone:870-447-2145
Mailing Address - Fax:
Practice Address - Street 1:209 OAK ST.
Practice Address - Street 2:
Practice Address - City:LESLIE
Practice Address - State:AR
Practice Address - Zip Code:72645
Practice Address - Country:US
Practice Address - Phone:870-447-6166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARDOM 001171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist