Provider Demographics
NPI:1609933555
Name:VIAFORA, JAN (DC)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:VIAFORA
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 1:5 NAVAJO RD
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-8927
Mailing Address - Country:US
Mailing Address - Phone:928-284-9550
Mailing Address - Fax:928-284-0246
Practice Address - Street 1:5 NAVAJO RD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-8927
Practice Address - Country:US
Practice Address - Phone:928-284-9550
Practice Address - Fax:928-284-0246
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3881111N00000X
AZ140171100000X
AZ2257225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ75251Medicare ID - Type Unspecified