Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 11082 | OR |
NPI | 1194854000 |
---|---|
Provider Name | Valerie Yuko Fitzgerald |
First Address | Newberg, OR 97132-3083 |
Second Address | Newberg, OR 97132-3083 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 10/06/2013 |