Provider Demographics
NPI:1275702516
Name:IRVINE, SHAWN MARKLE (DC CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:MARKLE
Last Name:IRVINE
Suffix:
Gender:M
Credentials:DC CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4039
Mailing Address - Country:US
Mailing Address - Phone:217-222-6500
Mailing Address - Fax:217-222-5688
Practice Address - Street 1:1024 MAINE ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4039
Practice Address - Country:US
Practice Address - Phone:217-222-6500
Practice Address - Fax:217-222-5688
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006381111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038006381Medicaid
IL038006381Medicaid