Healthcare Provider Details

I. General information

NPI: 1063968493
Provider Name (Legal Business Name): VICENT CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 ENCINITAS BLVD
ENCINITAS CA
92024-3728
US

IV. Provider business mailing address

447 ENCINITAS BLVD
ENCINITAS CA
92024-3728
US

V. Phone/Fax

Practice location:
  • Phone: 760-783-0105
  • Fax: 760-783-0193
Mailing address:
  • Phone: 760-783-0105
  • Fax: 760-783-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC33513
License Number StateCA

VIII. Authorized Official

Name: DR. VALERIE ROSE VICENT
Title or Position: OWNER
Credential: D.C.
Phone: 619-884-2721