Provider Demographics
NPI:1538881024
Name:JILLIAN E. BIVONA LLC
Entity type:Organization
Organization Name:JILLIAN E. BIVONA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:LEIGH ANNE
Authorized Official - Last Name:HICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-384-5358
Mailing Address - Street 1:301 22ND AVE E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-4023
Mailing Address - Country:US
Mailing Address - Phone:205-384-5358
Mailing Address - Fax:205-384-5360
Practice Address - Street 1:301 22ND AVE E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-4023
Practice Address - Country:US
Practice Address - Phone:205-384-5358
Practice Address - Fax:205-384-5360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty