Provider Demographics
NPI:1396704235
Name:VEGODSKY, STEVEN ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALAN
Last Name:VEGODSKY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 HYDRAULIC RIDGE RD
Mailing Address - Street 2:SUITE103
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8129
Mailing Address - Country:US
Mailing Address - Phone:434-973-1001
Mailing Address - Fax:434-973-7173
Practice Address - Street 1:233 HYDRAULIC RIDGE RD
Practice Address - Street 2:SUITE103
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8129
Practice Address - Country:US
Practice Address - Phone:434-973-1001
Practice Address - Fax:434-973-7173
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT21649Medicare UPIN
VA35000178Medicare ID - Type Unspecified