Provider Demographics
NPI:1629260575
Name:VALLEY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:VALLEY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:TRAVAGLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-624-0024
Mailing Address - Street 1:110 BAUGHMANS LN STE 200
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4916
Mailing Address - Country:US
Mailing Address - Phone:301-624-0024
Mailing Address - Fax:301-624-0026
Practice Address - Street 1:110 BAUGHMANS LN STE 200
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4916
Practice Address - Country:US
Practice Address - Phone:301-624-0024
Practice Address - Fax:301-624-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS02048111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCJ571-0001OtherCAREFIRST BC/BS
MD1584302OtherCAREFIRST BC/BS
MD1584302OtherCAREFIRST BC/BS
MD857MMedicare PIN