Provider Demographics
NPI:1134229776
Name:PAVITT, COREY M (DC)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:M
Last Name:PAVITT
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 1:10004 GLACIER HWY
Mailing Address - Street 2:STE. B
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8560
Mailing Address - Country:US
Mailing Address - Phone:907-790-2225
Mailing Address - Fax:907-789-5577
Practice Address - Street 1:10004 GLACIER HWY
Practice Address - Street 2:STE. B
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8560
Practice Address - Country:US
Practice Address - Phone:907-790-2225
Practice Address - Fax:907-789-5577
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCHI 272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK00020015225OtherTAT
AKCH0272Medicaid
92-0146428OtherFEDERAL TAX ID
AKCH0272Medicaid
U42529Medicare UPIN