Provider Demographics
NPI:1699138123
Name:VIRGIL, EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:VIRGIL
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:P.O BOX 2731
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72503
Mailing Address - Country:US
Mailing Address - Phone:870-569-4909
Mailing Address - Fax:870-569-4895
Practice Address - Street 1:920 HARRISON STREET
Practice Address - Street 2:SUITE A
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72503
Practice Address - Country:US
Practice Address - Phone:870-569-4909
Practice Address - Fax:870-569-4895
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13176111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor