Provider Demographics
NPI:1326347816
Name:IRVEN CHIROPRACTIC HEALTH CENTER,INC.
Entity Type:Organization
Organization Name:IRVEN CHIROPRACTIC HEALTH CENTER,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FICARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-795-9111
Mailing Address - Street 1:9030 W FORT ISLAND TRL
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-2412
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
Practice Address - Street 2:SUITE # 2
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-2412
Practice Address - Country:US
Practice Address - Phone:352-795-9111
Practice Address - Fax:352-795-0835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006794111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU51768Medicare UPIN
FL55168Medicare PIN