Provider Demographics
NPI:1194813675
Name:BELLONZI, VINCENT (DC,CCN)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:BELLONZI
Suffix:
Gender:M
Credentials:DC,CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S LAMAR BLVD
Mailing Address - Street 2:240
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8962
Mailing Address - Country:US
Mailing Address - Phone:512-473-8900
Mailing Address - Fax:512-472-9898
Practice Address - Street 1:1700 S LAMAR BLVD
Practice Address - Street 2:240
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8962
Practice Address - Country:US
Practice Address - Phone:512-473-8900
Practice Address - Fax:512-472-9898
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1181111N00000X
TX6272111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742704522OtherTAX IDENTIFICATION