Provider Demographics
NPI:1245221498
Name:AVERY, DAVID NICHOLAS (DC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:NICHOLAS
Last Name:AVERY
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 1:5645 GULF DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4019
Mailing Address - Country:US
Mailing Address - Phone:727-848-3663
Mailing Address - Fax:727-845-5691
Practice Address - Street 1:5645 GULF DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4019
Practice Address - Country:US
Practice Address - Phone:727-848-3663
Practice Address - Fax:727-845-5691
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH004405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T85406Medicare UPIN
FL70200AMedicare ID - Type Unspecified