Provider Demographics
NPI:1134634058
Name:ASENCIO, HECTOR IVAN (DC)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:IVAN
Last Name:ASENCIO
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 1:1523 ROSWELL RD APT 236
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-9027
Mailing Address - Country:US
Mailing Address - Phone:787-367-2743
Mailing Address - Fax:
Practice Address - Street 1:1523 ROSWELL RD APT 236
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-9027
Practice Address - Country:US
Practice Address - Phone:787-367-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO09987111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor