Provider Demographics
NPI:1457136152
Name:GUZALDO, VINCENT JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:JOSEPH
Last Name:GUZALDO
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 1:1317 S GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5113
Mailing Address - Country:US
Mailing Address - Phone:773-320-4206
Mailing Address - Fax:
Practice Address - Street 1:8600 W BRYN MAWR AVE STE 100N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3544
Practice Address - Country:US
Practice Address - Phone:773-930-4031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038014020111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor