Provider Demographics
NPI:1710024476
Name:VICK, ALBERT FISHER WOODRUFF III (DC)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:FISHER WOODRUFF
Last Name:VICK
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:CA
Mailing Address - Zip Code:95223-0007
Mailing Address - Country:US
Mailing Address - Phone:209-795-1470
Mailing Address - Fax:209-795-7545
Practice Address - Street 1:1280 OAK CIRCLE
Practice Address - Street 2:CEDAR CENTER
Practice Address - City:ARNOLD
Practice Address - State:CA
Practice Address - Zip Code:95223
Practice Address - Country:US
Practice Address - Phone:209-795-1470
Practice Address - Fax:209-795-7545
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11678111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor