=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720238959
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IRVIN CHIROPRACTIC & REHAB., PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2008
-----------------------------------------------------
Last Update Date | 02/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19295 W US HIGHWAY 82
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75092-5888
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-893-1144
-----------------------------------------------------
Fax | 903-893-4425
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19295 W US HIGHWAY 82
-----------------------------------------------------
City | SHERMAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75092-5888
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-893-1144
-----------------------------------------------------
Fax | 903-893-4425
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOSEPH D. IRVIN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 903-893-1144
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC7011
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------