Provider Demographics
NPI:1477306322
Name:VEGA CASIANO, RICARDO A (DC)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:A
Last Name:VEGA CASIANO
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 1:1234 RIDGEWOOD DR STE D
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2695
Mailing Address - Country:US
Mailing Address - Phone:419-352-0914
Mailing Address - Fax:419-754-2361
Practice Address - Street 1:1234 RIDGEWOOD DR STE D
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2695
Practice Address - Country:US
Practice Address - Phone:419-352-0914
Practice Address - Fax:419-754-2361
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH05304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor