MEDICARE: DR. MAXIE VIGE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	9381	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8A3720	OTHER	TX	BCBS PIN

General Provider Information

NPI Number	:	1043222904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAXIE VIGE D.C.

Provider Business Mailing Address
First Line	:	325 FM 517 RD E
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-8630
Country	:	US
Telephone Number	:	281-337-7000
Fax Number	:	281-337-7022

Provider Business Practice Location Address
First Line	:	325 FM 517 RD E
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-8630
Country	:	US
Telephone Number	:	281-337-7000
Fax Number	:	281-337-7022

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	02/20/2012

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Directions to “ DR. MAXIE VIGE D.C.” Practice Location

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