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NPI Code Detail

MEDICARE: MR. KREISTOPHER VALDES D.C.

MEDICARE: MR. KREISTOPHER VALDES D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorCH 10988FL

General Provider Information

NPI Number : 1063843811
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KREISTOPHER VALDES D.C.
Provider Business Mailing Address
First Line : 3476 OLYMPIC DR
Second Line :
City : GREEN COVE SPRINGS
State : FL
Zip : 32043-9202
Country : US
Telephone Number : 904-238-0680
Fax Number :
Provider Business Practice Location Address
First Line : 3476 OLYMPIC DR
Second Line :
City : GREEN COVE SPRINGS
State : FL
Zip : 32043-9202
Country : US
Telephone Number : 904-238-0680
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2013
Last Update Date : 12/04/2013

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