Provider Demographics
NPI:1588242820
Name:VASQUEZ, CHELSEA KAY (DC)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:KAY
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8661 XYLITE ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5004
Mailing Address - Country:US
Mailing Address - Phone:763-412-7184
Mailing Address - Fax:
Practice Address - Street 1:1935 COUNTY ROAD B2 W STE 185
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-2783
Practice Address - Country:US
Practice Address - Phone:612-424-5757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor