Victory Chiropractic, Inc.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

CH11707 Issued in FL

Legal business name

VICTORY CHIROPRACTIC, INC.

Practice address

3500 N State Road 7
Ste 480
Lauderdale Lakes, FL 33319-5600

Phone

(754) 215-6502

Fax

(954) 533-5242

NPI assigned

Jan 15, 2016

Last updated

Jan 21, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Victoria Widjaja, D.C.NPI 1851757033

Title

Administrator

Phone

(754) 215-6502

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Victoria Widjaja, D.C.

  • Chiropractor
  • Lauderdale Lakes, FL
  • NPI 1851757033
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453334400000",
    "number": "1992162325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 N STATE ROAD 7",
            "address_2": "STE 480",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333195600",
            "telephone_number": "754-215-6502",
            "fax_number": "954-533-5242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 N STATE ROAD 7",
            "address_2": "STE 480",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333195600",
            "telephone_number": "754-215-6502",
            "fax_number": "954-533-5242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY CHIROPRACTIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-15",
        "last_updated": "2016-01-21",
        "status": "A",
        "authorized_official_last_name": "WIDJAJA",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "754-215-6502",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH11707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vantage Medical Billing Solutions, LLC
• Juan Camilo Velasquez, M.D
• Ginna Sarai Velo Nazario
• Victoria Garden Alf, Inc.
• Victoria Gardens Home Alf Inc
• Andre Vicuna Blanco, BCBA
• Ramon Vidal, MD
• Stephanie Vietinghoff, MSN AGACNP
• Stephanie Franchesca Villadamigo, ARNP
• Ruben Villarreal, DMD

• Chiropractor in Lauderdale Lakes, FL
• Providers in Lauderdale Lakes, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.