1235358193 NPI number — DR. FRANCISCO A VAQUERO D.C P.C. D.C.

Table of content: ADRIENNE GRAYSON (NPI 1891142733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235358193 NPI number — DR. FRANCISCO A VAQUERO D.C P.C. D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAQUERO D.C P.C.
Provider First Name:
FRANCISCO
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235358193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
455 NIAGARA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14201-1834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-248-2825
Provider Business Mailing Address Fax Number:
716-248-2826

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 NIAGARA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14201-1834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-248-2825
Provider Business Practice Location Address Fax Number:
716-248-2826
Provider Enumeration Date:
04/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CHIR006449 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: X008141-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 694947 . This is a "ACN GROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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