Provider Demographics
NPI:1730450594
Name:VALLEY CHIROPRACTIC CENTER, PLLC
Entity type:Organization
Organization Name:VALLEY CHIROPRACTIC CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAPOBIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-361-9455
Mailing Address - Street 1:1200 VALLEY WEST DR STE 110
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1902
Mailing Address - Country:US
Mailing Address - Phone:515-868-0320
Mailing Address - Fax:
Practice Address - Street 1:1200 VALLEY WEST DR STE 110
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1902
Practice Address - Country:US
Practice Address - Phone:515-868-0320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06738111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty