Healthcare Provider Details

I. General information

NPI: 1326347816
Provider Name (Legal Business Name): IRVEN CHIROPRACTIC HEALTH CENTER,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 W FORT ISLAND TRL SUITE # 2
CRYSTAL RIVER FL
34429-2412
US

IV. Provider business mailing address

9030 W FORT ISLAND TRL SUITE # 2
CRYSTAL RIVER FL
34429-2412
US

V. Phone/Fax

Practice location:
  • Phone: 352-795-9111
  • Fax: 352-795-0835
Mailing address:
  • Phone: 352-795-9111
  • Fax: 352-795-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH0006794
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH0006794
License Number StateFL

VIII. Authorized Official

Name: MS. BARBARA FICARA
Title or Position: INSURANCE
Credential:
Phone: 352-795-9111