Provider Demographics
NPI:1881164846
Name:IRELAND, LIAM
Entity type:Individual
Prefix:
First Name:LIAM
Middle Name:
Last Name:IRELAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8885 RUDD RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-6325
Mailing Address - Country:US
Mailing Address - Phone:303-408-0369
Mailing Address - Fax:
Practice Address - Street 1:270 ALLES DR
Practice Address - Street 2:BUTLER-HANCOCK ATHLETICS CENTER
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-8063
Practice Address - Country:US
Practice Address - Phone:303-408-0369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer