Provider Demographics
NPI:1023042330
Name:IRVEN, NANCY I (DC)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:I
Last Name:IRVEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 W FORT ISLAND TRL STE 2
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-8011
Mailing Address - Country:US
Mailing Address - Phone:352-795-9111
Mailing Address - Fax:352-795-0835
Practice Address - Street 1:9030 W FORT ISLAND TRL STE 2
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-8011
Practice Address - Country:US
Practice Address - Phone:352-795-9111
Practice Address - Fax:352-795-0835
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006794111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU51768Medicare UPIN
FL55168Medicare ID - Type Unspecified