Provider Demographics
NPI:1083737472
Name:MULNICK, IRWIN (DC, CCSP)
Entity Type:Individual
Prefix:
First Name:IRWIN
Middle Name:
Last Name:MULNICK
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PARK ST.
Mailing Address - Street 2:PO BOX 1005
Mailing Address - City:MCCALL
Mailing Address - State:ID
Mailing Address - Zip Code:83638-1005
Mailing Address - Country:US
Mailing Address - Phone:208-634-8129
Mailing Address - Fax:208-634-7651
Practice Address - Street 1:201 PARK ST.
Practice Address - Street 2:
Practice Address - City:MCCALL
Practice Address - State:ID
Practice Address - Zip Code:83638-1005
Practice Address - Country:US
Practice Address - Phone:208-634-8129
Practice Address - Fax:208-634-7651
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA578111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010019939OtherBLUE SHIELD,IRWINMULNICK
IDC5782OtherBLUE CROSS, IRWIN MULNICK
ID1672404Medicare ID - Type UnspecifiedIRWIN MULNICK
IDC5782OtherBLUE CROSS, IRWIN MULNICK