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Individual

NICHOLAS VAN VALKENBURG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-5010
Mailing address
4315 WABASH AVE, SAINT LOUIS, MO 63109-1925

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2016032974
MO

Other

Enumeration date
01/06/2017
Last updated
01/06/2017
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