Provider Demographics
NPI:1275849424
Name:NIEVES, IVAN DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:DAVID
Last Name:NIEVES
Suffix:
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 1:3973 LONE EAGLE PL
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-5807
Mailing Address - Country:US
Mailing Address - Phone:321-297-5885
Mailing Address - Fax:
Practice Address - Street 1:3973 LONE EAGLE PL
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-5807
Practice Address - Country:US
Practice Address - Phone:321-297-5885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR535111N00000X
AZ8568111N00000X
FLCH 10065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor