Provider Demographics
NPI:1770663643
Name:IRWIN, ABIGAIL (DC, DACBSP)
Entity Type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:
Last Name:IRWIN
Suffix:
Gender:F
Credentials:DC, DACBSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 LAKESHORE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-1188
Mailing Address - Country:US
Mailing Address - Phone:510-893-1577
Mailing Address - Fax:510-893-8907
Practice Address - Street 1:2100 LAKESHORE AVE STE E
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-1188
Practice Address - Country:US
Practice Address - Phone:510-893-1577
Practice Address - Fax:510-893-8907
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT06614Medicare UPIN
CADC0180350Medicare ID - Type Unspecified