Provider Demographics
NPI:1841321684
Name:VALENTINE, LEONARD (DC)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:VALENTINE
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 1:17955 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5040
Mailing Address - Country:US
Mailing Address - Phone:714-964-9566
Mailing Address - Fax:714-963-1726
Practice Address - Street 1:17955 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5040
Practice Address - Country:US
Practice Address - Phone:714-964-9566
Practice Address - Fax:714-963-1726
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC158550111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0158550Medicare UPIN