Provider Demographics
NPI:1982114757
Name:VAZQUEZ, GRACE MARIE (DC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:MARIE
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 CENTRAL AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-4090
Mailing Address - Country:US
Mailing Address - Phone:941-444-6165
Mailing Address - Fax:
Practice Address - Street 1:13305 PANAMA CITY BEACH PKWY # 98
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-2844
Practice Address - Country:US
Practice Address - Phone:939-287-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-06
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor