Provider Demographics
NPI:1619042983
Name:PARENT, IRENE LOUISE (DC)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:LOUISE
Last Name:PARENT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-3037
Mailing Address - Country:US
Mailing Address - Phone:262-633-8160
Mailing Address - Fax:262-633-3512
Practice Address - Street 1:3204 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-3037
Practice Address - Country:US
Practice Address - Phone:262-633-8160
Practice Address - Fax:262-633-3512
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2466111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIUO6768Medicare UPIN