Provider Demographics
NPI:1508883331
Name:CARAVELLO, MICHELLE MARTINKOVIC (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:MARTINKOVIC
Last Name:CARAVELLO
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:PO BOX 515
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91376-0515
Mailing Address - Country:US
Mailing Address - Phone:818-735-7939
Mailing Address - Fax:
Practice Address - Street 1:3180 WILLOW LN
Practice Address - Street 2:SUITE 204
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-4941
Practice Address - Country:US
Practice Address - Phone:805-409-8000
Practice Address - Fax:805-495-4946
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA149521957OtherPROVIDER ID
CA149521957OtherPROVIDER ID
CADC26539Medicare ID - Type Unspecified