Provider Demographics
NPI:1689873473
Name:GAVIO, DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:GAVIO
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:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:50 MOISEY DRIVE
Practice Address - Street 2:SUITE 206
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202
Practice Address - Country:US
Practice Address - Phone:570-501-6700
Practice Address - Fax:570-501-3358
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101969314-0003Medicaid