Healthcare Provider Details

I. General information

NPI: 1386649457
Provider Name (Legal Business Name): JEFFREY S. CHIVINGTON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 ROYAL OAK DRIVE
ST. MARYS OH
45885
US

IV. Provider business mailing address

575 ROYAL OAK DRIVE
ST. MARYS OH
45885
US

V. Phone/Fax

Practice location:
  • Phone: 419-394-7124
  • Fax: 419-394-4288
Mailing address:
  • Phone: 419-394-7124
  • Fax: 419-394-4288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2355
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: