Provider Demographics
NPI:1992771828
Name:IVEY, THOMAS L (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:IVEY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:221 6TH AVE SE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4362
Mailing Address - Country:US
Mailing Address - Phone:605-225-7414
Mailing Address - Fax:605-225-7693
Practice Address - Street 1:221 6TH AVE SE
Practice Address - Street 2:SUITE 3
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4362
Practice Address - Country:US
Practice Address - Phone:605-225-7414
Practice Address - Fax:605-225-7693
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD571111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD76000060Medicaid
SD76000060Medicaid
SDT89024Medicare UPIN