Provider Demographics
NPI:1851465348
Name:TULLY, VALERIE DAWN (DC)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:DAWN
Last Name:TULLY
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 1:516 LAKEVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:516-775-0778
Mailing Address - Fax:516-775-0548
Practice Address - Street 1:516 LAKEVILLE ROAD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:516-775-0778
Practice Address - Fax:516-775-0548
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010347111N00000X
NJMC005836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
05399OtherGHI MEDICARE
647559OtherUNITED HEALTHCARE
CL03475BOtherNYS WORKERS COMPENSATION
833204OtherACN GROUP MPN
P2782088OtherOXFORD
X8K151OtherEMPIRE BLUE CROSS BLUE SH
P12035295OtherMULTIPLAN
5897399OtherGHI
05399OtherGHI MEDICARE
647559OtherUNITED HEALTHCARE