Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4858 | AZ |
N | 111NS0005X | Chiropractic Sports Physician | 4858 | AZ |
NPI | 1114017290 |
---|---|
Provider Name | Dr. Robert H Iversen |
First Address | Mc Lean, VA 22102-4311 |
Second Address | Phoenix, AZ 85008-1583 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 01/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
162173 | (05) | AZ |
2455228 | AETNA (01) | AZ |
AW2551 | HEALTHNET (01) | AZ |
AZ0242900 | BCBS (01) | AZ |
U28312 | (02) | AZ |