Provider Demographics
NPI:1427009380
Name:CAGLE, VICKI LYNNE (DC)
Entity Type:Individual
Prefix:DR
First Name:VICKI
Middle Name:LYNNE
Last Name:CAGLE
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:PO BOX 823
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-0823
Mailing Address - Country:US
Mailing Address - Phone:252-332-1990
Mailing Address - Fax:252-332-7620
Practice Address - Street 1:403 MAIN ST W
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3321
Practice Address - Country:US
Practice Address - Phone:252-332-1990
Practice Address - Fax:252-332-7620
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2122111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0829TOtherBCBS ID NUMBER
NC890829TMedicaid