Provider Demographics
NPI:1336211598
Name:VIGIL, DAVID ANDREW (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANDREW
Last Name:VIGIL
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 1:600 PACIFIC COAST HWY
Mailing Address - Street 2:#200
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6600
Mailing Address - Country:US
Mailing Address - Phone:562-596-1657
Mailing Address - Fax:562-799-3853
Practice Address - Street 1:600 PACIFIC COAST HWY
Practice Address - Street 2:#200
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6600
Practice Address - Country:US
Practice Address - Phone:562-596-1657
Practice Address - Fax:562-799-3853
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0161570OtherBLUE SHIELD OF CALIFORNIA
CADC16157Medicare PIN
CADC0161570OtherBLUE SHIELD OF CALIFORNIA