Provider Demographics
NPI:1003801531
Name:AGOSTINO VALLETTA, VIOLA A (DC)
Entity Type:Individual
Prefix:DR
First Name:VIOLA
Middle Name:A
Last Name:AGOSTINO VALLETTA
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 1:2026 LOGANS FERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068
Mailing Address - Country:US
Mailing Address - Phone:724-335-3696
Mailing Address - Fax:
Practice Address - Street 1:2026 LOGANS FERRY ROAD
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068
Practice Address - Country:US
Practice Address - Phone:724-335-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004329L111N00000X
PADC004329-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA605281OtherBCBS
PAU02151Medicare UPIN
PA605281Medicare ID - Type UnspecifiedMEDICARE