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General NPI Number Information
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NPI Number | 1437347713
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Entity Type | Organization
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Legal Business Name | IRWIN CHIROPRACTIC INC.
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 1545 SAINT MARKS PLZ STE 10
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City | STOCKTON
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State | CA
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Zip | 95207-6411
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Country | US
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Telephone | 209-951-8650
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Fax | 209-951-4659
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Provider Business Mailing Address
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Address Line | 1545 SAINT MARKS PLZ STE 10
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City | STOCKTON
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State | CA
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Zip | 95207-6411
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Country | US
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Telephone | 209-951-8650
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Fax | 209-951-4659
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES D IRWIN
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Credential | D.C.
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Telephone | 209-951-8650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC0109420
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License Number State | CA
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