Provider Demographics
NPI:1477545895
Name:VALENTINI CHIROPRACTIC CLINIC LTD PA
Entity Type:Organization
Organization Name:VALENTINI CHIROPRACTIC CLINIC LTD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:VALENTINI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-557-9032
Mailing Address - Street 1:4455 HIGHWAY 169 N
Mailing Address - Street 2:#200
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-2897
Mailing Address - Country:US
Mailing Address - Phone:763-557-9032
Mailing Address - Fax:763-557-5838
Practice Address - Street 1:4455 HIGHWAY 169 N
Practice Address - Street 2:#200
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-2897
Practice Address - Country:US
Practice Address - Phone:763-557-9032
Practice Address - Fax:763-557-5838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN60627FOOtherBC/BS
MN492728100Medicaid
MN492728100Medicaid
MN350002738Medicare ID - Type Unspecified