Provider Demographics
NPI:1821687286
Name:SHIVER, IAN (DC)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:
Last Name:SHIVER
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 1:2605 OLD FAIRWAY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-6401
Mailing Address - Country:US
Mailing Address - Phone:256-895-0606
Mailing Address - Fax:256-895-6400
Practice Address - Street 1:2605 OLD FAIRWAY RD STE 100
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-6401
Practice Address - Country:US
Practice Address - Phone:256-895-0606
Practice Address - Fax:256-895-6400
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor