Provider Demographics
NPI:1073608261
Name:VASQUEZ, ROBERT A (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:VASQUEZ
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 1:3700 CHEEK SPARGER
Mailing Address - Street 2:STE. 100
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021
Mailing Address - Country:US
Mailing Address - Phone:817-267-0102
Mailing Address - Fax:817-283-4755
Practice Address - Street 1:3700 CHEEK SPARGER
Practice Address - Street 2:STE. 100
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021
Practice Address - Country:US
Practice Address - Phone:817-267-0102
Practice Address - Fax:817-283-4755
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7892111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605815OtherBCBS PROVIDER NUMBER
TX8C2637Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER