Provider Demographics
NPI:1922468206
Name:VIGO CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:VIGO CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VIGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:386-734-4490
Mailing Address - Street 1:339 E NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-5509
Mailing Address - Country:US
Mailing Address - Phone:386-734-4490
Mailing Address - Fax:386-736-7556
Practice Address - Street 1:339 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-5509
Practice Address - Country:US
Practice Address - Phone:386-734-4490
Practice Address - Fax:386-736-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty