Provider Demographics
NPI:1750579538
Name:VAVIKOVA, DIANA (DC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:VAVIKOVA
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 1:1 MAIDEN LANE, 4TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038
Mailing Address - Country:US
Mailing Address - Phone:212-791-3388
Mailing Address - Fax:888-268-2484
Practice Address - Street 1:1 MAIDEN LANE, 4TH FLOOR
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3563
Practice Address - Country:US
Practice Address - Phone:212-791-3388
Practice Address - Fax:888-268-2484
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009246111NI0013X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX009246OtherLISCENSCE