Provider Demographics
NPI:1740389899
Name:VAN DEN VALENTYN, JON (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:VAN DEN VALENTYN
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 1:17605 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2313
Mailing Address - Country:US
Mailing Address - Phone:301-762-6686
Mailing Address - Fax:
Practice Address - Street 1:14800 PHYSICIANS LN
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3940
Practice Address - Country:US
Practice Address - Phone:301-762-6686
Practice Address - Fax:301-762-6646
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSO1642111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor