Provider Demographics
NPI:1669494407
Name:CIAVOLA, ELIZABETH M (DC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:M
Last Name:CIAVOLA
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:PO BOX 702
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18834
Mailing Address - Country:US
Mailing Address - Phone:570-465-9330
Mailing Address - Fax:570-465-9331
Practice Address - Street 1:17382 STATE RTE 11
Practice Address - Street 2:JOINES BLDG, SUITE 2
Practice Address - City:NEW MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18834
Practice Address - Country:US
Practice Address - Phone:570-465-9330
Practice Address - Fax:570-465-9331
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 009466111N00000X
NC3194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1829262OtherBLUE CROSS
V08240Medicare UPIN