Provider Demographics
NPI:1518366376
Name:WAITHE, AVIANNE (DC)
Entity type:Individual
Prefix:DR
First Name:AVIANNE
Middle Name:
Last Name:WAITHE
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 1:3723 72ND ST FL 1
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6126
Mailing Address - Country:US
Mailing Address - Phone:443-622-9429
Mailing Address - Fax:888-573-3898
Practice Address - Street 1:3723 72ND ST FL 1
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6126
Practice Address - Country:US
Practice Address - Phone:443-622-9429
Practice Address - Fax:888-573-3898
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00711200111NN1001X, 111NP0017X, 111N00000X
NYX013232111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty