Provider Demographics
NPI:1760963599
Name:DR VALIANT DIA CHIROPRACTIC PC
Entity Type:Organization
Organization Name:DR VALIANT DIA CHIROPRACTIC PC
Other - Org Name:TOTAL HEALTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VALIANT
Authorized Official - Middle Name:
Authorized Official - Last Name:DIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-742-0088
Mailing Address - Street 1:1176 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1229
Mailing Address - Country:US
Mailing Address - Phone:516-742-0088
Mailing Address - Fax:516-742-0234
Practice Address - Street 1:1176 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1229
Practice Address - Country:US
Practice Address - Phone:516-742-0088
Practice Address - Fax:516-742-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007359-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty