Provider Demographics
NPI:1629144142
Name:DR M.A. VEGA CHIROPRACTIC PHYSICIAN P.C.
Entity Type:Organization
Organization Name:DR M.A. VEGA CHIROPRACTIC PHYSICIAN P.C.
Other - Org Name:VEGA CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIRPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-581-1300
Mailing Address - Street 1:1405 W STATE HIGHWAY J
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-7473
Mailing Address - Country:US
Mailing Address - Phone:417-581-1300
Mailing Address - Fax:417-581-1388
Practice Address - Street 1:1405 W STATE HIGHWAY J
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7473
Practice Address - Country:US
Practice Address - Phone:417-581-1300
Practice Address - Fax:417-581-1388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000149664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000032175Medicare ID - Type Unspecified
1179390Medicare UPIN