Healthcare Provider Details

I. General information

NPI: 1922468206
Provider Name (Legal Business Name): VIGO CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 E NEW YORK AVE
DELAND FL
32724-5509
US

IV. Provider business mailing address

339 E NEW YORK AVE
DELAND FL
32724-5509
US

V. Phone/Fax

Practice location:
  • Phone: 386-734-4490
  • Fax: 386-736-7556
Mailing address:
  • Phone: 386-734-4490
  • Fax: 386-736-7556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH11298
License Number StateFL

VIII. Authorized Official

Name: DR. SUSAN LEE VIGO
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 386-734-4490