Provider Demographics
NPI:1093784753
Name:VALENCIA-LOPEZ, GLAEE G (DC)
Entity Type:Individual
Prefix:DR
First Name:GLAEE
Middle Name:G
Last Name:VALENCIA-LOPEZ
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 1:235 N EASTERN AVE
Mailing Address - Street 2:#119
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-4542
Mailing Address - Country:US
Mailing Address - Phone:702-307-4004
Mailing Address - Fax:702-307-9535
Practice Address - Street 1:235 N EASTERN AVE
Practice Address - Street 2:#119
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-4542
Practice Address - Country:US
Practice Address - Phone:702-307-4004
Practice Address - Fax:702-307-9535
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508352Medicaid