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NPI Code Detail

MEDICARE: VALIANT G DIA D.C.

MEDICARE: VALIANT G DIA 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
1111N00000XChiropractorX007359-1NY

General Provider Information

NPI Number : 1174656391
Entity Type Code : Individual
Provider Name (Legal Business Name) : VALIANT G DIA D.C.
Provider Business Mailing Address
First Line : 548 LARKFIELD RD
Second Line :
City : EAST NORTHPORT
State : NY
Zip : 11731-4204
Country : US
Telephone Number : 631-368-4018
Fax Number : 631-368-3109
Provider Business Practice Location Address
First Line : 548 LARKFIELD RD
Second Line :
City : EAST NORTHPORT
State : NY
Zip : 11731-4204
Country : US
Telephone Number : 631-368-4018
Fax Number : 631-368-3109
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 07/08/2007

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Directions to “ VALIANT G DIA D.C.” Practice Location

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