Provider Demographics
NPI:1902906639
Name:PAVLIK, DANIEL J JR (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:PAVLIK
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806
Mailing Address - Country:US
Mailing Address - Phone:407-423-4761
Mailing Address - Fax:407-422-9327
Practice Address - Street 1:2014 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806
Practice Address - Country:US
Practice Address - Phone:407-423-4761
Practice Address - Fax:407-422-9327
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11953531OtherCAQH
FL78052OtherBLUE CROSS BLUE SHILED
FL701721OtherUNITED HEALTH CARE