Provider Demographics
NPI:1881642502
Name:IRELAN, JAMES M (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:IRELAN
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 1:5353 MANHATTAN CIR STE 104
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4298
Mailing Address - Country:US
Mailing Address - Phone:303-926-0373
Mailing Address - Fax:
Practice Address - Street 1:5353 MANHATTAN CIR STE 104
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4298
Practice Address - Country:US
Practice Address - Phone:303-926-0373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO481286684OtherFEDERAL TAX ID NUMBER
CO481286684OtherFEDERAL TAX ID NUMBER