Provider Demographics
NPI:1235189713
Name:CIAVARRA, DAVID E (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:CIAVARRA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 W QUINCY ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-5925
Mailing Address - Country:US
Mailing Address - Phone:918-250-2273
Mailing Address - Fax:918-250-2272
Practice Address - Street 1:4800 W QUINCY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-5925
Practice Address - Country:US
Practice Address - Phone:918-250-2273
Practice Address - Fax:918-250-2272
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20060803111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK80715Medicare UPIN