Provider Demographics
NPI:1558570325
Name:ROBERT A VASQUEZ PC
Entity Type:Organization
Organization Name:ROBERT A VASQUEZ PC
Other - Org Name:VASQUEZ FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-267-0102
Mailing Address - Street 1:3700 CHEEK SPARGER RD.
Mailing Address - Street 2:STE. 100
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5709
Mailing Address - Country:US
Mailing Address - Phone:817-267-0102
Mailing Address - Fax:817-283-4755
Practice Address - Street 1:3700 CHEEK SPARGER RD.
Practice Address - Street 2:STE. 100
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5709
Practice Address - Country:US
Practice Address - Phone:817-267-0102
Practice Address - Fax:817-283-4755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7895111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00309XMedicare PIN