1376587048 NPI number — DR. ANTHONY JAMES PIVONKA D.C.

Table of content: DR. ANTHONY JAMES PIVONKA D.C. (NPI 1376587048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376587048 NPI number — DR. ANTHONY JAMES PIVONKA D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PIVONKA
Provider First Name:
ANTHONY
Provider Middle Name:
JAMES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376587048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1355 S. HIGLEY ROAD
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
HIGLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85236-4705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-892-0022
Provider Business Mailing Address Fax Number:
480-892-5509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1355 S. HIGLEY ROAD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
HIGLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85236-4705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-892-0022
Provider Business Practice Location Address Fax Number:
480-892-5509
Provider Enumeration Date:
06/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5506 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 3889 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AZ0933370 . This is a "BLUE CROSS BLUE SHIELD AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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