Provider Demographics
NPI:1447850003
Name:IVIE, TRITON (DC)
Entity type:Individual
Prefix:DR
First Name:TRITON
Middle Name:
Last Name:IVIE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9627
Mailing Address - Country:US
Mailing Address - Phone:435-265-8426
Mailing Address - Fax:
Practice Address - Street 1:454 PINE ST
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-9454
Practice Address - Country:US
Practice Address - Phone:360-376-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-31
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61099097111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor