Provider Demographics
NPI:1194900936
Name:VALKOS CHIROPRACTIC OFFICE, LLC
Entity type:Organization
Organization Name:VALKOS CHIROPRACTIC OFFICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VALKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-345-2785
Mailing Address - Street 1:106 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55041-1034
Mailing Address - Country:US
Mailing Address - Phone:651-345-2785
Mailing Address - Fax:651-345-5321
Practice Address - Street 1:106 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:MN
Practice Address - Zip Code:55041-1034
Practice Address - Country:US
Practice Address - Phone:651-345-2785
Practice Address - Fax:651-345-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002300261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3D991VAOtherBCBS INDIVIDUAL #
MN59660VAOtherBCBS FACILITY #
MN381328200Medicaid
MN90144935OtherWAUSAU
350053075OtherRAIL ROAD MEDICARE
MN5668059OtherAETNA
MN381328200Medicaid
MN350000383Medicare PIN