Provider Demographics
NPI:1578648036
Name:CARPENTER, VALARIE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:VALARIE
Middle Name:ANN
Last Name:CARPENTER
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 1:57731 JUAREZ DR
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-4442
Mailing Address - Country:US
Mailing Address - Phone:760-369-0344
Mailing Address - Fax:760-365-2660
Practice Address - Street 1:55898 29 PALMS HWY
Practice Address - Street 2:SUITE B
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-7806
Practice Address - Country:US
Practice Address - Phone:760-365-2600
Practice Address - Fax:760-365-2660
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU92105Medicare UPIN
CADC0282130Medicare ID - Type Unspecified