Provider Demographics
NPI:1114479383
Name:IBANEZ, VINCENT KENNETH (DC)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:KENNETH
Last Name:IBANEZ
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 CRAVENS AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2701
Mailing Address - Country:US
Mailing Address - Phone:310-499-6609
Mailing Address - Fax:
Practice Address - Street 1:1404 CRAVENS AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2701
Practice Address - Country:US
Practice Address - Phone:310-499-6609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor