Healthcare Provider Details

I. General information

NPI: 1255698684
Provider Name (Legal Business Name): RONALD JEAN VIGNEAU JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2836 E INDIAN SCHOOL RD STE A8
PHOENIX AZ
85016-6864
US

IV. Provider business mailing address

PO BOX 6610
CHANDLER AZ
85246-6610
US

V. Phone/Fax

Practice location:
  • Phone: 602-840-4056
  • Fax:
Mailing address:
  • Phone: 480-926-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8260
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: