Ava Self Management

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5015 Issued in TX

Legal business name

AVA SELF MANAGEMENT

Practice address

3001 W Waco Dr
Suite B
Waco, TX 76707-3272

Phone

(254) 756-4040

Fax

(254) 756-4042

NPI assigned

Aug 17, 2010

Last updated

Aug 17, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Vicki Riddling Ellison

Title

Ceo

Phone

(254) 756-4040

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1282003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282003200000",
    "number": "1700191525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 W WACO DR",
            "address_2": "SUITE B",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767073272",
            "telephone_number": "254-756-4040",
            "fax_number": "254-756-4042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 W WACO DR",
            "address_2": "SUITE B",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767073272",
            "telephone_number": "254-756-4040",
            "fax_number": "254-756-4042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVA SELF MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-17",
        "last_updated": "2010-08-17",
        "status": "A",
        "authorized_official_last_name": "ELLISON",
        "authorized_official_first_name": "VICKI",
        "authorized_official_middle_name": "RIDDLING",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "254-756-4040",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "TX",
            "license": "5015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Waco, TX
• Providers in Waco, TX by specialty
• Chiropractor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.