Provider Demographics
NPI:1790355162
Name:ELBOROUGH, IVYANNE V (DC)
Entity Type:Individual
Prefix:DR
First Name:IVYANNE
Middle Name:V
Last Name:ELBOROUGH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 CLARMAR DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2675
Mailing Address - Country:US
Mailing Address - Phone:608-274-1945
Mailing Address - Fax:608-318-5922
Practice Address - Street 1:707 PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:SAUK CITY
Practice Address - State:WI
Practice Address - Zip Code:53583-1364
Practice Address - Country:US
Practice Address - Phone:608-643-8643
Practice Address - Fax:608-643-4902
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI5643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor