Provider Demographics
NPI:1477304244
Name:VAZQUEZ, GEOVANNY (DC)
Entity Type:Individual
Prefix:DR
First Name:GEOVANNY
Middle Name:
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 1:21655 SW CEDAR BROOK WAY APT 164
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-5220
Mailing Address - Country:US
Mailing Address - Phone:503-290-8377
Mailing Address - Fax:
Practice Address - Street 1:170 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3729
Practice Address - Country:US
Practice Address - Phone:503-266-2997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6379111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor