Provider Demographics
NPI:1326191529
Name:AZEVEDO, KAREN (DC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:AZEVEDO
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 1:676 E 1ST AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3547
Mailing Address - Country:US
Mailing Address - Phone:530-893-9363
Mailing Address - Fax:
Practice Address - Street 1:676 E 1ST AVE STE 15
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3547
Practice Address - Country:US
Practice Address - Phone:530-893-9363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0225221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66762ZOtherBLUE SHIELD PROVIDER NUMB
CADC0225221OtherCHIROPRACTOR LICENSE NUMB
CAZZZ66762ZOtherBLUE SHIELD PROVIDER NUMB
CAZZZ03085ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER