Healthcare Provider Details

I. General information

NPI: 1891337853
Provider Name (Legal Business Name): ELLEN CHRISTY VEGA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3295 S COOPER ST STE 127
ARLINGTON TX
76015-2359
US

IV. Provider business mailing address

3295 S COOPER ST STE 127
ARLINGTON TX
76015-2359
US

V. Phone/Fax

Practice location:
  • Phone: 787-378-9393
  • Fax:
Mailing address:
  • Phone: 787-378-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number14242
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: