Provider Demographics
NPI:1588643951
Name:AVITT, LAURA A (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
Last Name:AVITT
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 1:1202 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-2802
Mailing Address - Country:US
Mailing Address - Phone:515-961-2400
Mailing Address - Fax:515-961-7963
Practice Address - Street 1:1202 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-2802
Practice Address - Country:US
Practice Address - Phone:515-961-2400
Practice Address - Fax:515-961-7963
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06698111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAFEDERAL TAX IDOther20-8551724