MEDICARE: DR. IVYANNE V ELBOROUGH DC

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
1	111N00000X	Chiropractor	5643	WI

General Provider Information

NPI Number	:	1790355162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVYANNE V ELBOROUGH DC

Provider Business Mailing Address
First Line	:	105 CLARMAR DR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-2675
Country	:	US
Telephone Number	:	608-274-1945
Fax Number	:	608-318-5922

Provider Business Practice Location Address
First Line	:	707 PHILLIPS BLVD
Second Line	:
City	:	SAUK CITY
State	:	WI
Zip	:	53583-1364
Country	:	US
Telephone Number	:	608-643-8643
Fax Number	:	608-643-4902

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2021
Last Update Date	:	06/29/2021

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