Provider Demographics
NPI:1760534887
Name:VARGAS, ROBERTO ANIBAL (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:ANIBAL
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 1:560 STRATFORD GRN
Mailing Address - Street 2:
Mailing Address - City:AVONDALE ESTATES
Mailing Address - State:GA
Mailing Address - Zip Code:30002-1354
Mailing Address - Country:US
Mailing Address - Phone:404-228-8234
Mailing Address - Fax:
Practice Address - Street 1:1375 PEACHTREE ST NE
Practice Address - Street 2:SUITE A9
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3173
Practice Address - Country:US
Practice Address - Phone:404-575-1300
Practice Address - Fax:404-575-1301
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor