Provider Demographics
NPI:1922165851
Name:AVIS, LORI MICHELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:MICHELLE
Last Name:AVIS
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 1:19215 SE 34TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-8829
Mailing Address - Country:US
Mailing Address - Phone:360-882-7733
Mailing Address - Fax:360-254-6821
Practice Address - Street 1:19215 SE 34TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-8829
Practice Address - Country:US
Practice Address - Phone:360-882-7733
Practice Address - Fax:360-254-6821
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272946111N00000X
WACH00034715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor