Provider Demographics
NPI:1447330121
Name:IRWIN, JAMES DONALD (DC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DONALD
Last Name:IRWIN
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 1:1545 SAINT MARKS PLZ
Mailing Address - Street 2:SUITE 10
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6411
Mailing Address - Country:US
Mailing Address - Phone:209-951-8650
Mailing Address - Fax:209-951-4659
Practice Address - Street 1:1545 SAINT MARKS PLZ
Practice Address - Street 2:SUITE 10
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6411
Practice Address - Country:US
Practice Address - Phone:209-951-8650
Practice Address - Fax:209-951-4659
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
CADC0109420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC010942)Medicare ID - Type Unspecified