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General NPI Number Information
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NPI Number | 1982114757
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Entity Type | Individual
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Provider Name | GRACE MARIE VAZQUEZ DC
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Gender | Female
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 13305 PANAMA CITY BEACH PKWY # 98
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City | PANAMA CITY BEACH
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State | FL
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Zip | 32407-2844
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Country | US
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Telephone | 939-287-2510
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Fax |
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Provider Business Mailing Address
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Address Line | 650 CENTRAL AVE STE 3
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City | SARASOTA
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State | FL
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Zip | 34236-4090
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Country | US
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Telephone | 941-444-6165
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH12323
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License Number State | FL
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