Provider Demographics
NPI:1437486123
Name:VICHETO, ANTHONY WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:WAYNE
Last Name:VICHETO
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 1:2200 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36107-1914
Mailing Address - Country:US
Mailing Address - Phone:228-669-8454
Mailing Address - Fax:
Practice Address - Street 1:3845 INTERSTATE CT STE 5
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-5223
Practice Address - Country:US
Practice Address - Phone:334-270-0284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor