Provider Demographics
NPI:1295199370
Name:PAVALKIS, JANE (DC)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:PAVALKIS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44330 PREMIER PLZ
Mailing Address - Street 2:SUITE #110A
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5070
Mailing Address - Country:US
Mailing Address - Phone:703-723-9355
Mailing Address - Fax:
Practice Address - Street 1:44330 PREMIER PLZ
Practice Address - Street 2:SUITE #110A
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5070
Practice Address - Country:US
Practice Address - Phone:703-723-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor