Provider Demographics
NPI:1740209931
Name:VEVODA, AMY CATHERINE (DC)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:CATHERINE
Last Name:VEVODA
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:PO BOX 8895
Mailing Address - Street 2:
Mailing Address - City:MAMMOTH LAKES
Mailing Address - State:CA
Mailing Address - Zip Code:93546-8861
Mailing Address - Country:US
Mailing Address - Phone:530-227-3525
Mailing Address - Fax:
Practice Address - Street 1:645 OLD MAMMOTH RD
Practice Address - Street 2:
Practice Address - City:MAMMOTH LAKES
Practice Address - State:CA
Practice Address - Zip Code:93546
Practice Address - Country:US
Practice Address - Phone:530-227-3525
Practice Address - Fax:760-544-6106
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB01762111N00000X
CA32517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAV10512Medicare UPIN