=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013897529
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IVEY POELLINGER DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2025
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 S SHILOH RD STE 400
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75042-8211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-840-2520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2712 LANDERSHIRE LN
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75023-7922
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-840-2520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 16471
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------