Provider Demographics
NPI:1952406878
Name:AVENI, MICHAEL D (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:AVENI
Suffix:
Gender:M
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 277
Mailing Address - Street 2:
Mailing Address - City:POLLOCK PINES
Mailing Address - State:CA
Mailing Address - Zip Code:95726
Mailing Address - Country:US
Mailing Address - Phone:530-644-3051
Mailing Address - Fax:530-644-7337
Practice Address - Street 1:6023 PONY EXPRESS TR
Practice Address - Street 2:
Practice Address - City:POLLOCK PINES
Practice Address - State:CA
Practice Address - Zip Code:95726
Practice Address - Country:US
Practice Address - Phone:530-644-3051
Practice Address - Fax:530-644-7337
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2011-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T18243Medicare UPIN
CAT18243Medicare ID - Type Unspecified