Provider Demographics
NPI:1467653576
Name:PIVONKA CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:PIVONKA CHIROPRACTIC, P.C.
Other - Org Name:PIVONKA FAMILY CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PIVONKA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-892-0022
Mailing Address - Street 1:1355 S HIGLEY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-4705
Mailing Address - Country:US
Mailing Address - Phone:480-892-0022
Mailing Address - Fax:480-892-5509
Practice Address - Street 1:1355 S HIGLEY RD STE 102
Practice Address - Street 2:
Practice Address - City:HIGLEY
Practice Address - State:AZ
Practice Address - Zip Code:85236-4705
Practice Address - Country:US
Practice Address - Phone:480-892-0022
Practice Address - Fax:480-892-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ108483Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER