Provider Demographics
NPI:1093764557
Name:VALCOURT, JAMIE L (DC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:VALCOURT
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 1:268 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5402
Mailing Address - Country:US
Mailing Address - Phone:508-235-1050
Mailing Address - Fax:508-235-0435
Practice Address - Street 1:268 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5402
Practice Address - Country:US
Practice Address - Phone:508-235-1050
Practice Address - Fax:508-235-0435
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2010-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3014111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAV10638Medicare UPIN
MAVA-Y45860Medicare PIN