Provider Demographics
NPI:1124099171
Name:IVEY, ROBIN GLENN JR (DC)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:GLENN
Last Name:IVEY
Suffix:JR
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:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-0041
Mailing Address - Country:US
Mailing Address - Phone:864-574-6840
Mailing Address - Fax:864-587-8227
Practice Address - Street 1:1230 JOHN B WHITE SR BLVD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-3929
Practice Address - Country:US
Practice Address - Phone:864-574-6840
Practice Address - Fax:864-587-8227
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH0985Medicaid
SCT23832Medicare UPIN