Healthcare Provider Details

I. General information

NPI: 1558654640
Provider Name (Legal Business Name): VIGOR CHIROPRACTIC & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4842 N KINGS HWY
FORT PIERCE FL
34951-2243
US

IV. Provider business mailing address

1924 WREN AVE
FORT PIERCE FL
34982-5635
US

V. Phone/Fax

Practice location:
  • Phone: 772-405-7877
  • Fax: 772-293-9163
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH10302
License Number StateFL

VIII. Authorized Official

Name: DR. ALLEN M RUPPERT
Title or Position: OWNER CHIROPRACTIC PHYSICIAN
Credential: DC
Phone: 772-405-7877