Provider Demographics
NPI:1841522422
Name:VILLEGAS LICONA, ALBERTO ISAAC (DC)
Entity type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:ISAAC
Last Name:VILLEGAS LICONA
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 1:261 N RUTH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4337
Mailing Address - Country:US
Mailing Address - Phone:651-714-4848
Mailing Address - Fax:
Practice Address - Street 1:261 N RUTH ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4337
Practice Address - Country:US
Practice Address - Phone:651-714-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5345111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor