Provider Demographics
NPI:1801001102
Name:CIVELLO SPINAL CENTER PLLC
Entity Type:Organization
Organization Name:CIVELLO SPINAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:CIVELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-615-1533
Mailing Address - Street 1:34441 8 MILE RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4013
Mailing Address - Country:US
Mailing Address - Phone:248-615-1533
Mailing Address - Fax:248-615-9068
Practice Address - Street 1:34441 8 MILE RD
Practice Address - Street 2:SUITE 116
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4013
Practice Address - Country:US
Practice Address - Phone:248-615-1533
Practice Address - Fax:248-615-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H223640OtherBCBS
MIOP13080Medicare ID - Type Unspecified
MIP13080001Medicare ID - Type UnspecifiedGROUP
MIU93520Medicare UPIN