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NPI Code Detail

MEDICARE: DR. ANTHONY JAMES PIVONKA D.C.

MEDICARE:  DR. ANTHONY JAMES PIVONKA  D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor5506AZ
2111N00000XChiropractor3889CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AZ0933370OTHERAZBLUE CROSS BLUE SHIELD AZ

General Provider Information

NPI Number : 1376587048
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANTHONY JAMES PIVONKA D.C.
Provider Business Mailing Address
First Line : 1355 S. HIGLEY ROAD
Second Line : STE 102
City : HIGLEY
State : AZ
Zip : 85236-4705
Country : US
Telephone Number : 480-892-0022
Fax Number : 480-892-5509
Provider Business Practice Location Address
First Line : 1355 S. HIGLEY ROAD
Second Line : STE 102
City : HIGLEY
State : AZ
Zip : 85236-4705
Country : US
Telephone Number : 480-892-0022
Fax Number : 480-892-5509
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 07/08/2007

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Directions to “ DR. ANTHONY JAMES PIVONKA D.C.” Practice Location

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