Provider Demographics
NPI:1184849853
Name:VASQUEZ, LEO ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:ANTHONY
Last Name:VASQUEZ
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 1:1718 FRY RD
Mailing Address - Street 2:#445
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5832
Mailing Address - Country:US
Mailing Address - Phone:713-334-3117
Mailing Address - Fax:713-779-2904
Practice Address - Street 1:1718 FRY RD
Practice Address - Street 2:#445
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-5832
Practice Address - Country:US
Practice Address - Phone:713-334-3117
Practice Address - Fax:713-779-2904
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8332111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation