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General NPI Number Information
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NPI Number | 1225541915
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Entity Type | Organization
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Legal Business Name | AEG CHIROPRACTIC
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 63 E SPAULDING AVE STE E114115
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City | PUEBLO WEST
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State | CO
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Zip | 81007-5416
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Country | US
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Telephone | 719-696-0280
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Fax |
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Provider Business Mailing Address
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Address Line | 63 E SPAULDING AVE STE E114115
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City | PUEBLO WEST
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State | CO
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Zip | 81007-5416
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Country | US
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Telephone | 719-696-0280
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Fax |
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Authorized Official
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Title or Position | CLINIC OWNER/DOCTOR
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Name | DR. ANGELA VIK
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Credential | D.C.
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Telephone | 719-696-0280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHR4489
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License Number State | CO
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