Provider Demographics
NPI:1417000696
Name:AZEVEDO CHIROPRACTIC CENTER P C
Entity Type:Organization
Organization Name:AZEVEDO CHIROPRACTIC CENTER P C
Other - Org Name:ADVANCED HEALTH & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:AZEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-893-9363
Mailing Address - Street 1:676 E 1ST AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3547
Mailing Address - Country:US
Mailing Address - Phone:530-893-9363
Mailing Address - Fax:
Practice Address - Street 1:676 E 1ST AVE STE 15
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3547
Practice Address - Country:US
Practice Address - Phone:530-893-9363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0225221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0225221OtherCHIROPRACTIC LICENSE NUMB
CAZZZ66762ZOtherBLUE SHIELD PROVIDER NUMB
CAZZZ66762ZOtherBLUE SHIELD PROVIDER NUMB
CAZZZ03085ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER