Provider Demographics
NPI:1730161803
Name:VASQUEZ, JOHN GEORGE II (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GEORGE
Last Name:VASQUEZ
Suffix:II
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 1:486 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROMWELL
Mailing Address - State:CT
Mailing Address - Zip Code:06416-2040
Mailing Address - Country:US
Mailing Address - Phone:860-632-7717
Mailing Address - Fax:
Practice Address - Street 1:486 MAIN ST
Practice Address - Street 2:
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416-2040
Practice Address - Country:US
Practice Address - Phone:860-632-7717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor