Provider Demographics
NPI:1558496711
Name:ALAVIAN, KEVIN (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:ALAVIAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16620 N 40TH ST
Mailing Address - Street 2:C1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3348
Mailing Address - Country:US
Mailing Address - Phone:602-923-6666
Mailing Address - Fax:602-923-7676
Practice Address - Street 1:16620 N 40TH STREET
Practice Address - Street 2:C1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2236
Practice Address - Country:US
Practice Address - Phone:602-923-6666
Practice Address - Fax:602-923-7676
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7119111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU87681Medicare UPIN
AZ68929Medicare ID - Type Unspecified