Individual
DR. ROBERT H IVERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C., C.C.S.P
Contact information
Practice address
2702 N 44TH ST, 101A, PHOENIX, AZ 85008-1583
(480) 990-9095
(480) 941-1233
Mailing address
1651 OLD MEADOW RD, STE 600, MC LEAN, VA 22102-4311
(703) 506-0213
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4858
AZ
111NS0005X
Sports Physician Chiropractor
4858
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
162173
—
AZ
01
—
2455228
AETNA
AZ
01
—
AW2551
HEALTHNET
AZ
01
—
AZ0242900
BCBS
AZ
Enumeration date
10/13/2006
Last updated
02/01/2010
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