Provider Demographics
NPI:1831104272
Name:PAVTIS, LAUREEN D (DC)
Entity type:Individual
Prefix:DR
First Name:LAUREEN
Middle Name:D
Last Name:PAVTIS
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 1:6638 E BASELINE RD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4432
Mailing Address - Country:US
Mailing Address - Phone:480-985-7070
Mailing Address - Fax:480-641-7048
Practice Address - Street 1:6638 E BASELINE RD
Practice Address - Street 2:SUITE #103
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4432
Practice Address - Country:US
Practice Address - Phone:480-985-7070
Practice Address - Fax:480-641-7048
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8169111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
9788344OtherCIGNA
PA1940642OtherBC/BS
665810OtherACN GROUP
665810OtherACN GROUP
901426Medicare ID - Type Unspecified