Provider Demographics
NPI:1659064715
Name:IVANS, AUSTIN DIRK (DC)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:DIRK
Last Name:IVANS
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 1:3356 IRONBOUND RD STE E305
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-2412
Mailing Address - Country:US
Mailing Address - Phone:559-904-6060
Mailing Address - Fax:
Practice Address - Street 1:3356 IRONBOUND RD STE E305
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2412
Practice Address - Country:US
Practice Address - Phone:559-904-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557824111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor