Provider Demographics
NPI:1942280318
Name:DEMPERIO, AVANDA JANE (DC)
Entity Type:Individual
Prefix:DR
First Name:AVANDA
Middle Name:JANE
Last Name:DEMPERIO
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 1:5803 W WILKINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-4809
Mailing Address - Country:US
Mailing Address - Phone:704-825-9799
Mailing Address - Fax:704-825-9977
Practice Address - Street 1:5803 W WILKINSON BLVD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-4809
Practice Address - Country:US
Practice Address - Phone:704-825-9799
Practice Address - Fax:704-825-9977
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0838EOtherBLUE CROSS/ BLUE SHIELD
NC890838EMedicaid
NCT64438Medicare UPIN
NC890838EMedicaid