Provider Demographics
NPI:1457427262
Name:CIVELLO, WILLIAM B (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:CIVELLO
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 1:14600 FARMINGTON RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:734-525-9588
Mailing Address - Fax:734-525-7986
Practice Address - Street 1:14600 FARMINGTON RD
Practice Address - Street 2:SUITE 106
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:734-525-9588
Practice Address - Fax:734-525-7986
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI8321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H223640OtherBCBS
MIOP13080Medicare ID - Type Unspecified
MIP13080001Medicare ID - Type Unspecified
MI950H223640OtherBCBS