MEDICARE: DR. GREGORY M AVEDISSIAN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	940	MA

General Provider Information

NPI Number	:	1033387493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY M AVEDISSIAN D.C.

Provider Business Mailing Address
First Line	:	721 PLEASANT ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01602-1904
Country	:	US
Telephone Number	:	508-757-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 PLEASANT ST
Second Line	:
City	:	WORCESTER
State	:	MA
Zip	:	01602-1904
Country	:	US
Telephone Number	:	508-757-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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