Provider Demographics
NPI:1942853668
Name:ALFRED R. VALENZUELA, D.C., INC.
Entity Type:Organization
Organization Name:ALFRED R. VALENZUELA, D.C., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:RICHAD
Authorized Official - Last Name:VALENZUELA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:808-747-1644
Mailing Address - Street 1:75-167 KALANI ST STE 101
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1800
Mailing Address - Country:US
Mailing Address - Phone:808-326-9355
Mailing Address - Fax:808-326-1997
Practice Address - Street 1:75-167 KALANI ST STE 101
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1800
Practice Address - Country:US
Practice Address - Phone:808-326-9355
Practice Address - Fax:808-326-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1467585042OtherOLD NPI NUMBER
HI374OtherDO NOT HAVE ANY OTHER NUMBER OTHER THAN NPI