Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 8260 | AZ |
Y | 111NR0400X | Rehabilitation Chiropractor | 4909 | AZ |
NPI | 1255698684 |
---|---|
Provider Name | Dr. Ronald Jean Vigneau JR. |
First Address | Tempe, AZ 85284-0020 |
Second Address | Tempe, AZ 85284-3224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2012 |
Last Update Date | 09/05/2013 |