Provider Demographics
NPI:1689651879
Name:VALCOURT, JACQUELINE LEGAULT (DC)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:LEGAULT
Last Name:VALCOURT
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 1:5745 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6326
Mailing Address - Country:US
Mailing Address - Phone:954-966-2211
Mailing Address - Fax:954-966-2370
Practice Address - Street 1:5745 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6326
Practice Address - Country:US
Practice Address - Phone:954-966-2211
Practice Address - Fax:954-966-2370
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH005725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT93992Medicare UPIN
FL22078Medicare ID - Type Unspecified