Individual
DR. IRA KEITH LAVENDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
2915 E BASELINE RD STE 126, GILBERT, AZ 85234-2475
(480) 325-6977
(602) 296-0487
Mailing address
2915 E BASELINE RD STE 126, GILBERT, AZ 85234-2475
(480) 325-6977
(602) 296-0487
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
6015
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669486908
MEDICARE GROUP NPI
AZ
01
—
63087
MEDICARE GROUP
AZ
01
—
AZ0932280
BLUE CROSS BLUE SHIELD
AZ
Enumeration date
12/05/2007
Last updated
10/30/2012
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