Provider Demographics
NPI:1124243787
Name:VALADEZ, JESSE W (DC)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:W
Last Name:VALADEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:NV
Mailing Address - Zip Code:89311-0044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 AVENUE F
Practice Address - Street 2:STE D
Practice Address - City:ELY
Practice Address - State:NV
Practice Address - Zip Code:89301-3506
Practice Address - Country:US
Practice Address - Phone:775-289-2002
Practice Address - Fax:775-289-2003
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6517471-1202111N00000X
NVB01384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor