Provider Demographics
NPI:1447388855
Name:VALENTINE, GREGORY J (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:VALENTINE
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 1:162 NORTH RAYMOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831
Mailing Address - Country:US
Mailing Address - Phone:714-738-0115
Mailing Address - Fax:714-525-0755
Practice Address - Street 1:162 NORTH RAYMOND AVENUE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831
Practice Address - Country:US
Practice Address - Phone:714-738-0115
Practice Address - Fax:714-525-0755
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC16571OtherPTAN
CADC16571OtherCHIROPRACTIC LICENSE
CADC0165710OtherBLUE SHIELD