Provider Demographics
NPI:1750444097
Name:IRELAND, TREVOR V (DC)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:V
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 1:541 W 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5804
Mailing Address - Country:US
Mailing Address - Phone:907-561-1222
Mailing Address - Fax:907-561-1350
Practice Address - Street 1:541 W 36TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5804
Practice Address - Country:US
Practice Address - Phone:907-561-1222
Practice Address - Fax:907-561-1350
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK72111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCH0075Medicaid
AKCH0075Medicaid
150700Medicare ID - Type Unspecified