Provider Demographics
NPI:1538435326
Name:MORALES, VANESSA (DC)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5646 MILTON ST
Mailing Address - Street 2:608A
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-3907
Mailing Address - Country:US
Mailing Address - Phone:469-554-8482
Mailing Address - Fax:
Practice Address - Street 1:5646 MILTON ST
Practice Address - Street 2:608A
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-3907
Practice Address - Country:US
Practice Address - Phone:469-554-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12039111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No111N00000XChiropractic ProvidersChiropractor