Provider Demographics
NPI:1326235839
Name:AVON CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:AVON CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARMIEN-RIVARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-226-8040
Mailing Address - Street 1:1241 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NY
Mailing Address - Zip Code:14414-9539
Mailing Address - Country:US
Mailing Address - Phone:585-226-8040
Mailing Address - Fax:585-226-3974
Practice Address - Street 1:1241 E RIVER RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:NY
Practice Address - Zip Code:14414-9539
Practice Address - Country:US
Practice Address - Phone:585-226-8040
Practice Address - Fax:585-226-3974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX52952Medicare UPIN
NYAA0584Medicare PIN
NYCC1718Medicare PIN