=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477545895
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALENTINI CHIROPRACTIC CLINIC LTD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2005
-----------------------------------------------------
Last Update Date | 03/06/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4455 HIGHWAY 169 N #200
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55442-2897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-557-9032
-----------------------------------------------------
Fax | 763-557-5838
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4455 HIGHWAY 169 N #200
-----------------------------------------------------
City | PLYMOUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55442-2897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-557-9032
-----------------------------------------------------
Fax | 763-557-5838
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | JOHN KENNETH VALENTINI
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 763-557-9032
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2548
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------