MEDICARE: DR. LAURA A AVITT DC

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	06698	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FEDERAL TAX ID	OTHER	IA	20-8551724

General Provider Information

NPI Number	:	1588643951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA A AVITT DC

Provider Business Mailing Address
First Line	:	1202 E 2ND AVE
Second Line	:
City	:	INDIANOLA
State	:	IA
Zip	:	50125-2802
Country	:	US
Telephone Number	:	515-961-2400
Fax Number	:	515-961-7963

Provider Business Practice Location Address
First Line	:	1202 E 2ND AVE
Second Line	:
City	:	INDIANOLA
State	:	IA
Zip	:	50125-2802
Country	:	US
Telephone Number	:	515-961-2400
Fax Number	:	515-961-7963

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	01/25/2012

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Directions to “ DR. LAURA A AVITT DC” Practice Location

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