Provider Demographics
NPI:1720238959
Name:IRVIN CHIROPRACTIC & REHAB., PA
Entity type:Organization
Organization Name:IRVIN CHIROPRACTIC & REHAB., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:IRVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-893-1144
Mailing Address - Street 1:19295 W US HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-5888
Mailing Address - Country:US
Mailing Address - Phone:903-893-1144
Mailing Address - Fax:903-893-4425
Practice Address - Street 1:19295 W US HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-5888
Practice Address - Country:US
Practice Address - Phone:903-893-1144
Practice Address - Fax:903-893-4425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC7011111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605510OtherBCBS
TX001941601Medicaid
TX00459WMedicare PIN