Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 10532 | TX |
N | 111NR0400X | Rehabilitation Chiropractor | 10532 | TX |
N | 111NX0100X | Occupational Health | 10532 | TX |
NPI | 1124162276 |
---|---|
Provider Name | Alfredo J Vazquez |
First Address | League City, TX 77573 |
Second Address | Dickinson, TX 77539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 30/04/2008 |