Provider Demographics
NPI:1386649457
Name:CHIVINGTON, JEFFREY S (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:CHIVINGTON
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 1:575 ROYAL OAK DRIVE
Mailing Address - Street 2:
Mailing Address - City:ST. MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885
Mailing Address - Country:US
Mailing Address - Phone:419-394-7124
Mailing Address - Fax:419-394-4288
Practice Address - Street 1:575 ROYAL OAK DRIVE
Practice Address - Street 2:
Practice Address - City:ST. MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885
Practice Address - Country:US
Practice Address - Phone:419-394-7124
Practice Address - Fax:419-394-4288
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0297923Medicaid
OHCH0812853Medicare ID - Type Unspecified
OH0297923Medicaid