Provider Demographics
NPI:1891739405
Name:PIVONKA, PATRICIA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:LYNN
Last Name:PIVONKA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 S. HIGLEY ROAD STE 102
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-4705
Mailing Address - Country:US
Mailing Address - Phone:480-892-0022
Mailing Address - Fax:480-892-5509
Practice Address - Street 1:1355 S. HIGLEY ROAD STE 102
Practice Address - Street 2:
Practice Address - City:HIGLEY
Practice Address - State:AZ
Practice Address - Zip Code:85236-4705
Practice Address - Country:US
Practice Address - Phone:480-892-0022
Practice Address - Fax:480-892-5509
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5505111N00000X
CO3790111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ 0242940OtherBLUECROSS BLUESHIELD AZ
AZAZ 0242940OtherBLUECROSS BLUESHIELD AZ
AZZ108485Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER