Provider Demographics
NPI:1457857773
Name:AVOLA, MOLLY CHRISTINE (DC)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:CHRISTINE
Last Name:AVOLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MS
Other - First Name:MOLLY
Other - Middle Name:CHRISTINE
Other - Last Name:LETOURNEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:171 S ORLANDO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-5653
Mailing Address - Country:US
Mailing Address - Phone:312-259-1113
Mailing Address - Fax:
Practice Address - Street 1:171 S ORLANDO AVE STE A
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5653
Practice Address - Country:US
Practice Address - Phone:312-259-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty