Provider Demographics
NPI:1710379383
Name:VELICHKO, IRINA (DC)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:VELICHKO
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 1:435 8TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3965
Mailing Address - Country:US
Mailing Address - Phone:510-858-5370
Mailing Address - Fax:510-868-5405
Practice Address - Street 1:435 8TH ST STE 203
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-3965
Practice Address - Country:US
Practice Address - Phone:510-858-5370
Practice Address - Fax:510-868-5405
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor