Provider Demographics
NPI:1336200021
Name:VALLEY CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:VALLEY CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:FREDRICK
Authorized Official - Last Name:FULK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-434-8066
Mailing Address - Street 1:7865 PARAGON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4039
Mailing Address - Country:US
Mailing Address - Phone:937-434-8066
Mailing Address - Fax:937-434-8066
Practice Address - Street 1:7865 PARAGON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4039
Practice Address - Country:US
Practice Address - Phone:937-434-8066
Practice Address - Fax:937-434-8366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9253781Medicare ID - Type Unspecified