Provider Demographics
NPI:1255322608
Name:VALENTINE, GEORGE D (DC PHC)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:D
Last Name:VALENTINE
Suffix:
Gender:M
Credentials:DC PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 WILLIAMS BLVD SW
Mailing Address - Street 2:STE 1
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-1480
Mailing Address - Country:US
Mailing Address - Phone:319-366-4118
Mailing Address - Fax:319-366-8615
Practice Address - Street 1:3255 WILLIAMS BLVD SW
Practice Address - Street 2:STE 1
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-1480
Practice Address - Country:US
Practice Address - Phone:319-366-4118
Practice Address - Fax:319-366-8615
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0075754Medicaid
00757OtherBCBS
U02962Medicare UPIN
IA0075754Medicaid