Provider Demographics
NPI:1013341528
Name:VIRGILIO, JAMES VINCENT (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:VINCENT
Last Name:VIRGILIO
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 1:3101 W HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5160
Mailing Address - Country:US
Mailing Address - Phone:954-983-8382
Mailing Address - Fax:954-983-8665
Practice Address - Street 1:3101 W HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009-5160
Practice Address - Country:US
Practice Address - Phone:954-983-8382
Practice Address - Fax:954-983-8665
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor