Provider Demographics
NPI:1225388069
Name:PAZ, GRISELL VIVIANA (DC)
Entity Type:Individual
Prefix:DR
First Name:GRISELL
Middle Name:VIVIANA
Last Name:PAZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BEACH PL
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-1800
Mailing Address - Country:US
Mailing Address - Phone:316-393-8328
Mailing Address - Fax:
Practice Address - Street 1:111 HIGH RIDGE RD
Practice Address - Street 2:CONNECTICUT SPINE AND HEALTH CENTER
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905
Practice Address - Country:US
Practice Address - Phone:203-967-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001898111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition