Provider Demographics
NPI:1124384524
Name:VINCE C. IRENE, DC., PLLC
Entity Type:Organization
Organization Name:VINCE C. IRENE, DC., PLLC
Other - Org Name:FAMILY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:IRENE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-332-4200
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY114702100Medicaid
WY114702100Medicaid