Healthcare Provider Details

I. General information

NPI: 1801001102
Provider Name (Legal Business Name): CIVELLO SPINAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34441 8 MILE RD SUITE 116
LIVONIA MI
48152-4013
US

IV. Provider business mailing address

34441 8 MILE RD SUITE 116
LIVONIA MI
48152-4013
US

V. Phone/Fax

Practice location:
  • Phone: 248-615-1533
  • Fax: 248-615-9068
Mailing address:
  • Phone: 248-615-1533
  • Fax: 248-615-9068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM B CIVELLO
Title or Position: OWNER
Credential: DC
Phone: 248-615-1533