Provider Demographics
NPI:1518366376
Name:WAITHE, AVIANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:AVIANNE
Middle Name:
Last Name:WAITHE
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 1:2482A 5TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7840
Mailing Address - Country:US
Mailing Address - Phone:443-622-9429
Mailing Address - Fax:
Practice Address - Street 1:610 NEWARK AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2300
Practice Address - Country:US
Practice Address - Phone:201-963-0800
Practice Address - Fax:201-656-6934
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00711200111N00000X, 111NN1001X, 111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor