Provider Demographics
NPI:1902432958
Name:CHIRKOV, IRINA
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:CHIRKOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 NE 7TH ST APT Y1
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-4986
Mailing Address - Country:US
Mailing Address - Phone:360-513-6294
Mailing Address - Fax:
Practice Address - Street 1:12014 SE MILL PLAIN BLVD STE 120
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4044
Practice Address - Country:US
Practice Address - Phone:360-892-0199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61015121225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist