Provider Demographics
NPI:1306989397
Name:IRWIN, THOMAS C (BA, DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:IRWIN
Suffix:
Gender:M
Credentials:BA, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32103 CEDAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444-8559
Mailing Address - Country:US
Mailing Address - Phone:541-247-0902
Mailing Address - Fax:
Practice Address - Street 1:94241 SIXTH ST
Practice Address - Street 2:
Practice Address - City:GOLD BEACH
Practice Address - State:OR
Practice Address - Zip Code:97444
Practice Address - Country:US
Practice Address - Phone:866-308-4213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 2223111N00000X
CA17931111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDC0179310Medicare ID - Type Unspecified