Provider Demographics
NPI:1376635870
Name:VAEZI, PEYMAN (DC)
Entity Type:Individual
Prefix:DR
First Name:PEYMAN
Middle Name:
Last Name:VAEZI
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 1:1940 CROWS LANDING RD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358-6103
Mailing Address - Country:US
Mailing Address - Phone:209-538-2600
Mailing Address - Fax:209-538-2640
Practice Address - Street 1:1940 CROWS LANDING RD
Practice Address - Street 2:SUITE #4
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358-6103
Practice Address - Country:US
Practice Address - Phone:209-538-2600
Practice Address - Fax:209-538-2640
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor