Provider Demographics
NPI:1841716453
Name:RAHN, IVY JOY (DC)
Entity type:Individual
Prefix:
First Name:IVY
Middle Name:JOY
Last Name:RAHN
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 1:12333 NW 18TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4386
Mailing Address - Country:US
Mailing Address - Phone:954-961-6161
Mailing Address - Fax:954-404-6704
Practice Address - Street 1:12333 NW 18TH ST STE 1
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4386
Practice Address - Country:US
Practice Address - Phone:954-961-6161
Practice Address - Fax:954-404-6704
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor