Provider Demographics
NPI:1891337853
Name:VEGA, ELLEN CHRISTY (DC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:CHRISTY
Last Name:VEGA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3295 S COOPER ST STE 127
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2359
Mailing Address - Country:US
Mailing Address - Phone:787-378-9393
Mailing Address - Fax:
Practice Address - Street 1:3295 S COOPER ST STE 127
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2359
Practice Address - Country:US
Practice Address - Phone:787-378-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14242111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty