Provider Demographics
NPI:1073705331
Name:VAZQUEZ, CARLOS MANUEL (DC)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:MANUEL
Last Name:VAZQUEZ
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:PO BOX 150272
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-6272
Mailing Address - Country:US
Mailing Address - Phone:817-265-5200
Mailing Address - Fax:817-795-8100
Practice Address - Street 1:2017 S COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5537
Practice Address - Country:US
Practice Address - Phone:817-265-5200
Practice Address - Fax:817-795-8100
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor