Provider Demographics
NPI:1760652036
Name:VALENTINI, JOHN KENNETH (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KENNETH
Last Name:VALENTINI
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 1:4900 HIGHWAY 169 N STE 250
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55428-4019
Mailing Address - Country:US
Mailing Address - Phone:763-432-0116
Mailing Address - Fax:763-951-2263
Practice Address - Street 1:4455 HIGHWAY 169 N
Practice Address - Street 2:STE 200
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-2897
Practice Address - Country:US
Practice Address - Phone:763-557-9032
Practice Address - Fax:763-557-9838
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN00F10VAOtherBC/BS
MN492728100Medicaid
MN350002738OtherMEDICARE ID
MN00F10VAOtherBC/BS