Basic Information
| Provider Information | |||||||||
| NPI: | 1457673030 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERCADO | ||||||||
| FirstName: | AVELIZA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 E MAIN ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374081609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236432246 | ||||||||
| FaxNumber: | 4236432030 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 E 3RD ST | ||||||||
| Address2: | SUITE G-100 | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374032241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236432246 | ||||||||
| FaxNumber: | 4236432030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2010 | ||||||||
| LastUpdateDate: | 01/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | ACU112 | TN | Y | Other Service Providers | Acupuncturist |
No ID Information.