Provider Demographics
NPI:1558325936
Name:VALERIA, DANIEL ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROBERT
Last Name:VALERIA
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 1:4041 GEORGETOWN CIR
Mailing Address - Street 2:
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6207
Mailing Address - Country:US
Mailing Address - Phone:847-658-3660
Mailing Address - Fax:847-658-5418
Practice Address - Street 1:1204 E. ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102
Practice Address - Country:US
Practice Address - Phone:847-658-3660
Practice Address - Fax:847-658-5418
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL562180Medicare ID - Type Unspecified
ILU77828Medicare UPIN