Provider Demographics
NPI:1417559055
Name:IVIE FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:IVIE FAMILY CHIROPRACTIC PLLC
Other - Org Name:FAMILY TREE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRITON
Authorized Official - Middle Name:
Authorized Official - Last Name:IVIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-265-8426
Mailing Address - Street 1:837 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9627
Mailing Address - Country:US
Mailing Address - Phone:435-265-8426
Mailing Address - Fax:
Practice Address - Street 1:454 PINE ST
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-9454
Practice Address - Country:US
Practice Address - Phone:360-376-5575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-09
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center