Provider Demographics
NPI:1265508931
Name:VARGO, RONALD WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WILLIAM
Last Name:VARGO
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 1:105 WALTER WAY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3999
Mailing Address - Country:US
Mailing Address - Phone:770-312-4900
Mailing Address - Fax:770-312-4900
Practice Address - Street 1:105 WALTER WAY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3999
Practice Address - Country:US
Practice Address - Phone:770-312-4900
Practice Address - Fax:770-312-4900
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27371111N00000X
GACHIR008251111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor