Provider Demographics
NPI:1033633722
Name:AVALLON, DAVID C
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:AVALLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 POST ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824
Mailing Address - Country:US
Mailing Address - Phone:203-955-1147
Mailing Address - Fax:203-955-1148
Practice Address - Street 1:1 ATLANTIC ST STE 201
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-2438
Practice Address - Country:US
Practice Address - Phone:203-355-2225
Practice Address - Fax:203-355-2235
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2079OtherCONNECTICUT