MEDICARE: DR M.A. VEGA CHIROPRACTIC PHYSICIAN P.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	2000149664	MO

General Provider Information

NPI Number	:	1629144142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR M.A. VEGA CHIROPRACTIC PHYSICIAN P.C.

Provider Business Mailing Address
First Line	:	1405 W STATE HIGHWAY J
Second Line	:
City	:	OZARK
State	:	MO
Zip	:	65721-7473
Country	:	US
Telephone Number	:	417-581-1300
Fax Number	:	417-581-1388

Provider Business Practice Location Address
First Line	:	1405 W STATE HIGHWAY J
Second Line	:
City	:	OZARK
State	:	MO
Zip	:	65721-7473
Country	:	US
Telephone Number	:	417-581-1300
Fax Number	:	417-581-1388

Authorized Official
Title or Position	:	CHIRPRACTIC PHYSICIAN
Name	:	DR. MICHAEL A VEGA
Credential	:	DC
Telephone Number	:	417-581-1300

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	01/09/2014

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