MEDICARE: DR. NANCY I IRVEN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH0006794	FL
2	111NN1001X	Nutrition Chiropractor	CH0006794	FL

General Provider Information

NPI Number	:	1023042330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY I IRVEN D.C.

Provider Business Mailing Address
First Line	:	9030 W FORT ISLAND TRL STE 2
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-8011
Country	:	US
Telephone Number	:	352-795-9111
Fax Number	:	352-795-0835

Provider Business Practice Location Address
First Line	:	9030 W FORT ISLAND TRL STE 2
Second Line	:
City	:	CRYSTAL RIVER
State	:	FL
Zip	:	34429-8011
Country	:	US
Telephone Number	:	352-795-9111
Fax Number	:	352-795-0835

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	09/09/2010

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