Provider Demographics
NPI:1083797013
Name:SURACE, VINCENT JOSEPH SR (DC)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOSEPH
Last Name:SURACE
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:28134 S WESTERN AVE # 196
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-1248
Mailing Address - Country:US
Mailing Address - Phone:310-893-9954
Mailing Address - Fax:714-547-5694
Practice Address - Street 1:928 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-2427
Practice Address - Country:US
Practice Address - Phone:310-850-0989
Practice Address - Fax:714-547-5694
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01-10283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor