Provider Demographics
NPI:1154810141
Name:FAVEREY, ELAINE (DC)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:FAVEREY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 NE FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4919
Mailing Address - Country:US
Mailing Address - Phone:541-388-3588
Mailing Address - Fax:541-388-0839
Practice Address - Street 1:424 NE FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4919
Practice Address - Country:US
Practice Address - Phone:541-388-3588
Practice Address - Fax:541-388-0839
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor