Provider Demographics
NPI:1295747004
Name:VELAZQUEZ VEGA, JUAN A (DC)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:A
Last Name:VELAZQUEZ VEGA
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:PO BOX 1180
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-1180
Mailing Address - Country:US
Mailing Address - Phone:787-360-8315
Mailing Address - Fax:
Practice Address - Street 1:20 CALLE DEL RIO N
Practice Address - Street 2:OFIC. 1A
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4881
Practice Address - Country:US
Practice Address - Phone:787-360-8315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR243111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor