Provider Demographics
NPI:1619099637
Name:VALLEROY, ANTHONY TODD (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:TODD
Last Name:VALLEROY
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 1:421 HARTMANN LN
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1858
Mailing Address - Country:US
Mailing Address - Phone:618-939-4158
Mailing Address - Fax:
Practice Address - Street 1:305 S MOORE ST STE A
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1328
Practice Address - Country:US
Practice Address - Phone:618-939-4700
Practice Address - Fax:618-939-5867
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5470950OtherCCN
IL199367OtherBCBS MISSOURI
IL06732010OtherBCBS ILLINOIS
IL2122751OtherFIRST HEALTH
IL611690OtherHEALTHLINK
IL655439OtherUNITED HEALTHCARE
IL06732010OtherBCBS ILLINOIS
IL2122751OtherFIRST HEALTH