Provider Demographics
NPI:1447391784
Name:VEGA, EDWIN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:VEGA
Suffix:JR
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 1:1732 RIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2157
Mailing Address - Country:US
Mailing Address - Phone:585-266-2782
Mailing Address - Fax:585-266-2785
Practice Address - Street 1:1732 RIDGE RD E
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2157
Practice Address - Country:US
Practice Address - Phone:585-266-2782
Practice Address - Fax:585-266-2785
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010869-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7475597OtherAETNA
NY145441ANOtherPREFERRED CARE
NYC10869-8WOtherWORKMANS COMPENSATION
NY7475597OtherAETNA
NY145441ANOtherPREFERRED CARE