Provider Demographics
NPI:1740278597
Name:PAVELSKI, MICHELE LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:LYNN
Last Name:PAVELSKI
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 1:182 MAIN ST
Mailing Address - Street 2:PO BOX 484
Mailing Address - City:NEW MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18834-2114
Mailing Address - Country:US
Mailing Address - Phone:570-465-3444
Mailing Address - Fax:570-465-5400
Practice Address - Street 1:182 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18834-2114
Practice Address - Country:US
Practice Address - Phone:570-465-3444
Practice Address - Fax:570-465-5400
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC0078136111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA838244OtherBLUE SHIELD
PA2374009OtherAETNA
PA0018053640001Medicaid
PA838244OtherBLUE SHIELD
U81043Medicare UPIN