Provider Demographics
NPI:1316377328
Name:VIVODA, ABIGAIL NOEL (DC)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:NOEL
Last Name:VIVODA
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 1:10324 HATHAWAY DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-8126
Mailing Address - Country:US
Mailing Address - Phone:616-328-9461
Mailing Address - Fax:
Practice Address - Street 1:10324 HATHAWAY DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-8126
Practice Address - Country:US
Practice Address - Phone:616-328-9461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010142111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor