Provider Demographics
NPI:1861426025
Name:BRIAN V. AVITABILE
Entity type:Organization
Organization Name:BRIAN V. AVITABILE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:AVITABILE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-532-1000
Mailing Address - Street 1:1000 BEAR CAT WAY
Mailing Address - Street 2:SUITE #101
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6619
Mailing Address - Country:US
Mailing Address - Phone:919-532-1000
Mailing Address - Fax:919-532-1600
Practice Address - Street 1:1000 BEAR CAT WAY
Practice Address - Street 2:SUITE #101
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6619
Practice Address - Country:US
Practice Address - Phone:919-532-1000
Practice Address - Fax:919-532-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU73998Medicare UPIN