Provider Demographics
NPI:1245917509
Name:LISCIO, AVALON L
Entity type:Individual
Prefix:
First Name:AVALON
Middle Name:L
Last Name:LISCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BOBOLINK CT
Mailing Address - Street 2:UNIT A
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-2468
Mailing Address - Country:US
Mailing Address - Phone:239-821-0434
Mailing Address - Fax:
Practice Address - Street 1:18 BOBOLINK CT
Practice Address - Street 2:UNIT A
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-2468
Practice Address - Country:US
Practice Address - Phone:239-821-0434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor