Provider Demographics
NPI:1255955928
Name:RODRIGUEZ-VAZQUEZ, RICARDO ALEJANDRO (DC)
Entity type:Individual
Prefix:
First Name:RICARDO ALEJANDRO
Middle Name:
Last Name:RODRIGUEZ-VAZQUEZ
Suffix:
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 1:7686 RICHMOND HWY STE 115
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-2800
Mailing Address - Country:US
Mailing Address - Phone:571-255-8333
Mailing Address - Fax:
Practice Address - Street 1:7686 RICHMOND HWY STE 115
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-2800
Practice Address - Country:US
Practice Address - Phone:571-255-8333
Practice Address - Fax:571-255-8333
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0104557630OtherDC LICENSE