Provider Demographics
NPI:1316290844
Name:STAR VALLEY CHIROPRACTIC,P.C.
Entity type:Organization
Organization Name:STAR VALLEY CHIROPRACTIC,P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-885-4325
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110-0488
Mailing Address - Country:US
Mailing Address - Phone:307-885-4325
Mailing Address - Fax:307-885-4327
Practice Address - Street 1:109 HOSPITAL LANE
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110
Practice Address - Country:US
Practice Address - Phone:307-885-4325
Practice Address - Fax:307-885-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty