Provider Demographics
NPI:1669510533
Name:IRELAND, DAVID RUSSELL (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RUSSELL
Last Name:IRELAND
Suffix:
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 1:515 S BEACON BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1996
Mailing Address - Country:US
Mailing Address - Phone:616-846-5330
Mailing Address - Fax:
Practice Address - Street 1:515 S BEACON BLVD
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1996
Practice Address - Country:US
Practice Address - Phone:616-846-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDI005855111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95-0-G0-5377OtherBLUE SHIELD
MI95-0-G0-5377OtherBLUE CROSS
MI0-E3-50186-952Medicare ID - Type Unspecified
MIU48524Medicare UPIN