Provider Demographics
NPI:1982753257
Name:PAVELONIS, KEVIN TODD (BADC)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:TODD
Last Name:PAVELONIS
Suffix:
Gender:M
Credentials:BADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-2606
Mailing Address - Country:US
Mailing Address - Phone:502-447-3333
Mailing Address - Fax:502-447-3387
Practice Address - Street 1:4640 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-2606
Practice Address - Country:US
Practice Address - Phone:502-447-3333
Practice Address - Fax:502-447-3387
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2437190000OtherPASSPORT ADVANTAGE
KY1122687OtherPASSPORT
KY85036481Medicaid
KY6087001Medicare ID - Type UnspecifiedMEDICARE
KY1122687OtherPASSPORT