Provider Demographics
NPI:1467585042
Name:VALENZUELA, ALFRED RICHARD (DC)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:RICHARD
Last Name:VALENZUELA
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 1:75-5706 HANAMA PL
Mailing Address - Street 2:SUITE 204
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1745
Mailing Address - Country:US
Mailing Address - Phone:808-329-0547
Mailing Address - Fax:808-326-1535
Practice Address - Street 1:75-5706 HANAMA PL
Practice Address - Street 2:SUITE 204
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1745
Practice Address - Country:US
Practice Address - Phone:808-329-0547
Practice Address - Fax:808-326-1535
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI374111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI5930 3OtherBCBS
HI5930 3OtherBCBS