Provider Demographics
NPI:1538121132
Name:IVEY, DAVID HARVEY II (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HARVEY
Last Name:IVEY
Suffix:II
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 1:801 W BROADWAY STE 4
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2236
Mailing Address - Country:US
Mailing Address - Phone:502-407-9812
Mailing Address - Fax:
Practice Address - Street 1:801 W BROADWAY STE 4
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2236
Practice Address - Country:US
Practice Address - Phone:502-407-9812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2708111N00000X
KY5339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2708Medicaid
SCCH2708Medicaid