MEDICARE: DR. VANESSA VAJDOS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	9718	TX

General Provider Information

NPI Number	:	1457512733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANESSA VAJDOS D.C.

Provider Business Mailing Address
First Line	:	1428 TERMINAL LOOP
Second Line	:
City	:	MC QUEENEY
State	:	TX
Zip	:	78123-3351
Country	:	US
Telephone Number	:	830-557-6740
Fax Number	:

Provider Business Practice Location Address
First Line	:	1428 TERMINAL LOOP
Second Line	:
City	:	MC QUEENEY
State	:	TX
Zip	:	78123-3351
Country	:	US
Telephone Number	:	830-557-6740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	11/02/2009

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