Provider Demographics
NPI:1679813018
Name:VALLES, JUDE HENRY (DC)
Entity Type:Individual
Prefix:DR
First Name:JUDE
Middle Name:HENRY
Last Name:VALLES
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 1:2272 NORBURY DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-5203
Mailing Address - Country:US
Mailing Address - Phone:678-357-2200
Mailing Address - Fax:
Practice Address - Street 1:1054 STONE MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30049
Practice Address - Country:US
Practice Address - Phone:678-357-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007551111N00000X
FLCH8452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor