Healthcare Provider Details

I. General information

NPI: 1033136122
Provider Name (Legal Business Name): JON MICHAEL VEZENDY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20723 TORRENCE CHAPEL RD STE 201
CORNELIUS NC
28031-6399
US

IV. Provider business mailing address

20723 TORRENCE CHAPEL RD STE 201
CORNELIUS NC
28031-6399
US

V. Phone/Fax

Practice location:
  • Phone: 704-895-2240
  • Fax: 704-765-4077
Mailing address:
  • Phone: 704-895-2240
  • Fax: 704-765-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License NumberNC3013
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: