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NPI Code Detail

MEDICARE: AVILA INTEGRATIVE MEDICINE, INC.

MEDICARE: AVILA INTEGRATIVE MEDICINE, INC.
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
1225100000XPhysical Therapist7987CO
2111N00000XChiropractor4867CO
3208VP0000XPain Medicine Physician31499CO

General Provider Information

NPI Number : 1821363557
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVILA INTEGRATIVE MEDICINE, INC.
Provider Business Mailing Address
First Line : 3960 IVYWOOD LN
Second Line :
City : PUEBLO
State : CO
Zip : 81005-2567
Country : US
Telephone Number : 719-565-1276
Fax Number : 719-565-2313
Provider Business Practice Location Address
First Line : 3960 IVYWOOD LN
Second Line :
City : PUEBLO
State : CO
Zip : 81005-2567
Country : US
Telephone Number : 719-565-1276
Fax Number : 719-565-2313
Authorized Official
Title or Position : PRESIDENT
Name : DR. ROBERT J AVILA
Credential : D.C., CCST, CCCN
Telephone Number : 719-565-1276
Provider Enumeration Date : 03/13/2012
Last Update Date : 02/05/2016

Similar Medicare Providers

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Practice Fax: 719-565-2313
1013381698 — KAMALA RIES SLP
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81005-2567
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3960 IVYWOOD LN
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1801359203 — CARRIE RAYE GRAVATT M.A., CCC-SLP
Practice Location Address:
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