Provider Demographics
NPI:1932345527
Name:FEVRY, LAVAUD (ADMINISTRATOR)
Entity Type:Individual
Prefix:MR
First Name:LAVAUD
Middle Name:
Last Name:FEVRY
Suffix:
Gender:M
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 SILVER STAR RD SUITE 210
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-3140
Mailing Address - Country:US
Mailing Address - Phone:407-704-8766
Mailing Address - Fax:407-704-8763
Practice Address - Street 1:6900 SILVER STAR RD STE 210
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-3140
Practice Address - Country:US
Practice Address - Phone:407-704-8766
Practice Address - Fax:407-704-8763
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC6718111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation