Provider Demographics
NPI:1396816971
Name:IPC, INC. DBA ISLAND PARK CHIROPRACTIC
Entity type:Organization
Organization Name:IPC, INC. DBA ISLAND PARK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-554-9994
Mailing Address - Street 1:417 XYZ RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ARENAS VALLEY
Mailing Address - State:NM
Mailing Address - Zip Code:88022-9755
Mailing Address - Country:US
Mailing Address - Phone:541-554-9994
Mailing Address - Fax:
Practice Address - Street 1:301 W COLLEGE AVE STE 10
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5002
Practice Address - Country:US
Practice Address - Phone:575-493-8009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR118128Medicare UPIN