Provider Demographics
NPI:1689188203
Name:LOPEZ VAZQUEZ, NATALIA M
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:M
Last Name:LOPEZ VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 FALLS OF NEUSE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3525
Mailing Address - Country:US
Mailing Address - Phone:198-769-4729
Mailing Address - Fax:
Practice Address - Street 1:6009 FALLS OF NEUSE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3525
Practice Address - Country:US
Practice Address - Phone:919-876-9472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009962111N00000X
NC5124111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor