Healthcare Provider Details

I. General information

NPI: 1003801531
Provider Name (Legal Business Name): VIOLA A AGOSTINO VALLETTA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2026 LOGANS FERRY ROAD
NEW KENSINGTON PA
15068
US

IV. Provider business mailing address

2026 LOGANS FERRY ROAD
NEW KENSINGTON PA
15068
US

V. Phone/Fax

Practice location:
  • Phone: 724-335-3696
  • Fax:
Mailing address:
  • Phone: 724-335-3696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC004329L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC004329-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: