Provider Demographics
NPI:1104856129
Name:VALOV, VASSIL I (DC)
Entity Type:Individual
Prefix:
First Name:VASSIL
Middle Name:I
Last Name:VALOV
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 1:56 CANARY PALM CT
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-6100
Mailing Address - Country:US
Mailing Address - Phone:716-308-5283
Mailing Address - Fax:904-862-2662
Practice Address - Street 1:254 EVEREST LN
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259
Practice Address - Country:US
Practice Address - Phone:904-862-2662
Practice Address - Fax:904-862-2662
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1634111N00000X
FLCH12184111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432191999Medicaid
ME6034814OtherCIGNA
ME100338OtherBC/BS
ME432191999Medicaid
MEV09064Medicare UPIN