Provider Demographics
NPI:1992811244
Name:IRENE, VINCE C (DC)
Entity type:Individual
Prefix:
First Name:VINCE
Middle Name:C
Last Name:IRENE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 HIGHWAY 789
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-2926
Mailing Address - Country:US
Mailing Address - Phone:307-332-4200
Mailing Address - Fax:307-332-3133
Practice Address - Street 1:8135 HIGHWAY 789
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-2926
Practice Address - Country:US
Practice Address - Phone:307-332-4200
Practice Address - Fax:307-332-3133
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW305874Medicare PIN