Provider Demographics
NPI:1427169614
Name:IRONWOOD CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:IRONWOOD CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:EVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-667-0823
Mailing Address - Street 1:1410 LINCOLN WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2300
Mailing Address - Country:US
Mailing Address - Phone:208-667-0823
Mailing Address - Fax:
Practice Address - Street 1:1410 LINCOLN WAY STE 200
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2300
Practice Address - Country:US
Practice Address - Phone:208-667-0823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty