Healthcare Provider Details

I. General information

NPI: 1427392331
Provider Name (Legal Business Name): JAIME M IRVING LMT, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 NAKOOSA TRL
MADISON WI
53714-1379
US

IV. Provider business mailing address

4001 NAKOOSA TRL STE 203
MADISON WI
53714-1381
US

V. Phone/Fax

Practice location:
  • Phone: 608-285-9000
  • Fax:
Mailing address:
  • Phone: 608-213-3664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number744-55
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number11116-146
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: