Provider Demographics
NPI:1134172240
Name:VALLE, JENS EMILIO (DC)
Entity type:Individual
Prefix:DR
First Name:JENS
Middle Name:EMILIO
Last Name:VALLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4290 BELLS FERRY RD NW
Mailing Address - Street 2:SUITE #118
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7140
Mailing Address - Country:US
Mailing Address - Phone:770-924-4700
Mailing Address - Fax:770-924-4713
Practice Address - Street 1:4290 BELLS FERRY RD NW
Practice Address - Street 2:SUITE #118
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7140
Practice Address - Country:US
Practice Address - Phone:770-924-4700
Practice Address - Fax:770-924-4713
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2915111N00000X
TN640111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor