Provider Demographics
NPI:1912184391
Name:VALLE, MANUEL ERNESTO (DC)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ERNESTO
Last Name:VALLE
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 1:2165 FOURTH ST STE A
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4569
Mailing Address - Country:US
Mailing Address - Phone:925-292-5850
Mailing Address - Fax:925-449-1302
Practice Address - Street 1:2165 FOURTH ST STE A
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4569
Practice Address - Country:US
Practice Address - Phone:925-292-5850
Practice Address - Fax:925-449-1302
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor