Provider Demographics
NPI:1619049145
Name:GAVIGLIO, ADRIAN STEVEN (DOCTOR OF CHIROPRACT)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:STEVEN
Last Name:GAVIGLIO
Suffix:
Gender:M
Credentials:DOCTOR OF CHIROPRACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 ELIZABETH LK RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3017
Mailing Address - Country:US
Mailing Address - Phone:248-681-7655
Mailing Address - Fax:248-681-4088
Practice Address - Street 1:3801 ELIZABETH LK RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3017
Practice Address - Country:US
Practice Address - Phone:248-681-7655
Practice Address - Fax:248-681-4088
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2098168Medicaid
T33364Medicare UPIN
0F35094Medicare ID - Type Unspecified