Provider Demographics
NPI:1639918279
Name:LOWE, IVY NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:IVY
Middle Name:NICOLE
Last Name:LOWE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:IVY
Other - Middle Name:NICOLE
Other - Last Name:KOLB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 N CAMPUS PKWY APT 5103
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1274
Mailing Address - Country:US
Mailing Address - Phone:618-878-9374
Mailing Address - Fax:
Practice Address - Street 1:208 FOX HILL RD STE C
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-1780
Practice Address - Country:US
Practice Address - Phone:757-850-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557993111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor