Healthcare Provider Details

I. General information

NPI: 1578268108
Provider Name (Legal Business Name): LIZARIE M CIURO VAZQUEZ DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 09/25/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10306 SHELBYVILLE RD
LOUISVILLE KY
40223-2914
US

IV. Provider business mailing address

10306 SHELBYVILLE RD
LOUISVILLE KY
40223-2914
US

V. Phone/Fax

Practice location:
  • Phone: 502-245-7334
  • Fax: 502-245-7187
Mailing address:
  • Phone: 502-245-7334
  • Fax: 502-245-7187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number284357
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: