Provider Demographics
NPI:1154629731
Name:VALLIS, DORI (ND)
Entity Type:Individual
Prefix:DR
First Name:DORI
Middle Name:
Last Name:VALLIS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 BLACK BEAR TRL
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-6095
Mailing Address - Country:US
Mailing Address - Phone:203-770-8128
Mailing Address - Fax:
Practice Address - Street 1:459 BLACK BEAR TRL STE B
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-6095
Practice Address - Country:US
Practice Address - Phone:203-770-8128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000244175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath