MEDICARE: DR. GLAEE G VALENCIA-LOPEZ DC

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
1	111N00000X	Chiropractor	B01163	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093784753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLAEE G VALENCIA-LOPEZ DC

Provider Business Mailing Address
First Line	:	235 N EASTERN AVE
Second Line	:	#119
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-4542
Country	:	US
Telephone Number	:	702-307-4004
Fax Number	:	702-307-9535

Provider Business Practice Location Address
First Line	:	235 N EASTERN AVE
Second Line	:	#119
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-4542
Country	:	US
Telephone Number	:	702-307-4004
Fax Number	:	702-307-9535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	03/03/2009

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Directions to “ DR. GLAEE G VALENCIA-LOPEZ DC” Practice Location

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