Provider Demographics
NPI:1659565109
Name:IVY CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:IVY CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-945-9096
Mailing Address - Street 1:8404 W 13TH ST N
Mailing Address - Street 2:#150
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-2978
Mailing Address - Country:US
Mailing Address - Phone:316-945-9096
Mailing Address - Fax:316-722-1120
Practice Address - Street 1:8404 W 13TH ST N
Practice Address - Street 2:#150
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-2978
Practice Address - Country:US
Practice Address - Phone:316-945-9096
Practice Address - Fax:316-722-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS14185OtherBCBS OF KANSAS
KS14185OtherBCBS OF KANSAS