Provider Demographics
NPI:1467596742
Name:TAVITIAN, SILVA (DC)
Entity Type:Individual
Prefix:DR
First Name:SILVA
Middle Name:
Last Name:TAVITIAN
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 1:5386 HAVERFORD MILL CV
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5974
Mailing Address - Country:US
Mailing Address - Phone:770-923-6967
Mailing Address - Fax:
Practice Address - Street 1:3993 LAVISTA RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5139
Practice Address - Country:US
Practice Address - Phone:770-270-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO08901111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition