MEDICARE: JEAN MARIE VAZQUEZ BLAKE DC

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	1134	PR

General Provider Information

NPI Number	:	1639049026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN MARIE VAZQUEZ BLAKE DC

Provider Business Mailing Address
First Line	:	CUPEY
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	CUPEY
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-412-2228
Fax Number	:

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

Provider Enumeration Date	:	11/10/2025
Last Update Date	:	03/05/2026

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