Provider Demographics
NPI:1659553303
Name:DAVERSA, ALDO (DC)
Entity Type:Individual
Prefix:
First Name:ALDO
Middle Name:
Last Name:DAVERSA
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 1:6959 ARAPAHO RD
Mailing Address - Street 2:#573
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248
Mailing Address - Country:US
Mailing Address - Phone:972-233-2929
Mailing Address - Fax:972-233-2929
Practice Address - Street 1:6959 ARAPAHO RD
Practice Address - Street 2:#573
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248
Practice Address - Country:US
Practice Address - Phone:972-233-2929
Practice Address - Fax:972-233-2929
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX7834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor