Provider Demographics
NPI:1679397251
Name:DA VIRRO, ADAM DAVID (LAC)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:DAVID
Last Name:DA VIRRO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:251 CHAVEZ RANCH RD
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-6717
Mailing Address - Country:US
Mailing Address - Phone:928-310-8919
Mailing Address - Fax:
Practice Address - Street 1:2940 SOUTHWEST DR STE 3
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-3717
Practice Address - Country:US
Practice Address - Phone:928-310-8919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-000638171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist