Provider Demographics
NPI:1598856072
Name:IRWIN, JOHN SAMUEL IV (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SAMUEL
Last Name:IRWIN
Suffix:IV
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 POPWELL AVE
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-2324
Mailing Address - Country:US
Mailing Address - Phone:205-755-4430
Mailing Address - Fax:205-755-4472
Practice Address - Street 1:104 POPWELL AVENUE
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2324
Practice Address - Country:US
Practice Address - Phone:205-755-4430
Practice Address - Fax:205-755-4472
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51553204OtherBCBS OF AL PROVIDER ID
AL51553204OtherBCBS OF AL PROVIDER ID
AL051553204Medicare ID - Type UnspecifiedMEDICARE ID NUMBER