Provider Demographics
NPI:1871082545
Name:VANGURP, ALBERTO JR (DC)
Entity type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:
Last Name:VANGURP
Suffix:JR
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 1:9018 IRON OAK AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3162
Mailing Address - Country:US
Mailing Address - Phone:340-332-6000
Mailing Address - Fax:
Practice Address - Street 1:1501 W REYNOLDS ST STE 101
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4707
Practice Address - Country:US
Practice Address - Phone:340-332-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor