Provider Demographics
NPI:1750466991
Name:VARGAS, EDGARDO ROBERTO (DC)
Entity Type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:ROBERTO
Last Name:VARGAS
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 1:5625 N SPAULDING AVE
Mailing Address - Street 2:UNIT 1N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3675
Mailing Address - Country:US
Mailing Address - Phone:630-706-1432
Mailing Address - Fax:
Practice Address - Street 1:3300 N PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4010
Practice Address - Country:US
Practice Address - Phone:773-777-0709
Practice Address - Fax:773-777-0734
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-010690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor