Provider Demographics
NPI:1386090298
Name:VASQUEZ, JUSTIN
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8683 E LINCOLN AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-9811
Mailing Address - Country:US
Mailing Address - Phone:720-440-1980
Mailing Address - Fax:
Practice Address - Street 1:8683 E LINCOLN AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-9811
Practice Address - Country:US
Practice Address - Phone:720-440-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor