Healthcare Provider Details

I. General information

NPI: 1528711595
Provider Name (Legal Business Name): VALENTINE SPINE & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 09/14/2023
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 EXECUTIVE PARK DR STE 110
SHARONVILLE OH
45241-2022
US

IV. Provider business mailing address

4875 MAXWELL DR
MASON OH
45040-4626
US

V. Phone/Fax

Practice location:
  • Phone: 513-268-5227
  • Fax: 812-519-1708
Mailing address:
  • Phone: 513-673-1597
  • Fax: 812-519-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN L YOUNG
Title or Position: MEMBER
Credential:
Phone: 513-673-1597