Healthcare Provider Details

I. General information

NPI: 1952406878
Provider Name (Legal Business Name): MICHAEL D AVENI DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 01/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6023 PONY EXPRESS TR
POLLOCK PINES CA
95726
US

IV. Provider business mailing address

PO BOX 277
POLLOCK PINES CA
95726
US

V. Phone/Fax

Practice location:
  • Phone: 530-644-3051
  • Fax: 530-644-7337
Mailing address:
  • Phone: 530-644-3051
  • Fax: 530-644-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC16097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: