Provider Demographics
NPI:1871639401
Name:ARGENIO, VINCENT ROSS (DC)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:ROSS
Last Name:ARGENIO
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 1:135 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640
Mailing Address - Country:US
Mailing Address - Phone:520-655-4404
Mailing Address - Fax:520-655-4562
Practice Address - Street 1:135 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640
Practice Address - Country:US
Practice Address - Phone:520-655-4404
Practice Address - Fax:520-655-4562
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007061L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01654591Medicaid
U68417Medicare UPIN
PA901261UG1Medicare ID - Type Unspecified