Healthcare Provider Details

I. General information

NPI: 1740209931
Provider Name (Legal Business Name): AMY CATHERINE VEVODA D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 OLD MAMMOTH RD
MAMMOTH LAKES CA
93546
US

IV. Provider business mailing address

PO BOX 8895
MAMMOTH LAKES CA
93546-8861
US

V. Phone/Fax

Practice location:
  • Phone: 530-227-3525
  • Fax: 760-544-6106
Mailing address:
  • Phone: 530-227-3525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberB01762
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: