Provider Demographics
NPI:1053513465
Name:AVAKIAN, STACI (DC)
Entity type:Individual
Prefix:DR
First Name:STACI
Middle Name:
Last Name:AVAKIAN
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 1:1464 HARDING RD
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-6526
Mailing Address - Country:US
Mailing Address - Phone:609-364-1999
Mailing Address - Fax:
Practice Address - Street 1:1464 HARDING RD
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-6526
Practice Address - Country:US
Practice Address - Phone:609-364-1999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00657300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor