Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 1181 | NM |
Y | 111NN1001X | Nutrition | 6272 | TX |
NPI | 1194813675 |
---|---|
Provider Name | Dr. Vincent Bellonzi |
First Address | Austin, TX 78704-8962 |
Second Address | Austin, TX 78704-8962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 31/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
742704522 | TAX IDENTIFICATION (01) | TX |