Provider Demographics
NPI:1407670441
Name:VELAZQUEZ BISBAL, ANIBAL J JR (DC)
Entity type:Individual
Prefix:DR
First Name:ANIBAL
Middle Name:J
Last Name:VELAZQUEZ BISBAL
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 N SWALLOW TAIL DR APT 1507
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-4157
Mailing Address - Country:US
Mailing Address - Phone:787-685-5295
Mailing Address - Fax:
Practice Address - Street 1:877 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-6522
Practice Address - Country:US
Practice Address - Phone:407-889-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor