Provider Demographics
NPI:1083731871
Name:VALLEJOS, NICOLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:
Last Name:VALLEJOS
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 1:1001 BRIDGEWAY # 234
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2104
Mailing Address - Country:US
Mailing Address - Phone:415-375-8010
Mailing Address - Fax:
Practice Address - Street 1:108 CALEDONIA ST STE A
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-1973
Practice Address - Country:US
Practice Address - Phone:415-375-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29484111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology