Provider Contract Termination

 

ALERT: Tivity / Alternative Medicine Providers

STOP. DO NOT COMPLETE THIS FORM. All massage therapists, acupuncturists, chiropractors, and naturopaths, please contact Tivity / WholeHealthNetworks for terminations and demographic changes at practitioner.updates@tivityhealth.com


Kaiser Permanente can only make changes to these alternative and complementary medicine practitioner types once Tivity has confirmed the details. Thank you.

 
 
 
 
 
Phone
 

 

PROVIDER INFO

 
 
 
 
 
 
 

FORMAL NOTIFICATION REQUIRED:

Notification is required per Section XII. Duration and Termination. Please upload this documentation below:

 
Drop your files here