Provider Demographics
NPI:1154098549
Name:VALLEJO, DEANNA MERCEDES (DC)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:MERCEDES
Last Name:VALLEJO
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 1:817 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10977-6314
Mailing Address - Country:US
Mailing Address - Phone:845-352-7166
Mailing Address - Fax:
Practice Address - Street 1:80 5TH AVE RM 1205
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8016
Practice Address - Country:US
Practice Address - Phone:212-924-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor