Provider Demographics
NPI:1679285738
Name:VAZQUEZ, GUILLERMO DAVID
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:DAVID
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 KELLER WAY # 100
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-2515
Mailing Address - Country:US
Mailing Address - Phone:214-402-2861
Mailing Address - Fax:
Practice Address - Street 1:2245 KELLER WAY # 100
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-2515
Practice Address - Country:US
Practice Address - Phone:214-402-2861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor