Provider Demographics
NPI:1144383274
Name:IVY, RICHARD GLENN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GLENN
Last Name:IVY
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7706 LEDBETTER
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001
Mailing Address - Country:US
Mailing Address - Phone:817-538-3649
Mailing Address - Fax:817-538-3649
Practice Address - Street 1:7511 US HIGHWAY 287
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001
Practice Address - Country:US
Practice Address - Phone:817-538-3649
Practice Address - Fax:817-538-3649
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX2809111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX14008Medicare UPIN