Provider Demographics
NPI:1689884959
Name:DIAZ, VALENTIN A (DC)
Entity Type:Individual
Prefix:
First Name:VALENTIN
Middle Name:A
Last Name:DIAZ
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 1:401 41ST ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-4915
Mailing Address - Country:US
Mailing Address - Phone:201-864-5312
Mailing Address - Fax:201-864-0088
Practice Address - Street 1:401 41ST ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4915
Practice Address - Country:US
Practice Address - Phone:201-864-5312
Practice Address - Fax:201-864-0088
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ01526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ451072Medicare UPIN