Provider Demographics
NPI:1679791644
Name:VIGIL, JAMES THEODORE (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:THEODORE
Last Name:VIGIL
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 1:110 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WALSENBURG
Mailing Address - State:CO
Mailing Address - Zip Code:81089-2020
Mailing Address - Country:US
Mailing Address - Phone:719-738-3808
Mailing Address - Fax:719-738-3808
Practice Address - Street 1:110 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WALSENBURG
Practice Address - State:CO
Practice Address - Zip Code:81089-2020
Practice Address - Country:US
Practice Address - Phone:719-738-3808
Practice Address - Fax:719-738-3808
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5081111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00147521OtherRAILROAD MEDICARE NUMBER
COC523568Medicare ID - Type UnspecifiedMEDICARE PART B NUMBER
COP00147521OtherRAILROAD MEDICARE NUMBER