Provider Demographics
NPI:1518174143
Name:VAILLANCOURT, CHRISTINE LOUISE (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:VAILLANCOURT
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 1:1045 GARDEN OF THE GODS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-9428
Mailing Address - Country:US
Mailing Address - Phone:719-599-4646
Mailing Address - Fax:719-528-3911
Practice Address - Street 1:1045 GARDEN OF THE GODS RD
Practice Address - Street 2:SUITE A
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-9428
Practice Address - Country:US
Practice Address - Phone:719-599-4646
Practice Address - Fax:719-528-3911
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor