Provider Demographics
NPI:1447478094
Name:IRVINE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:IRVINE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:IRVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-839-2225
Mailing Address - Street 1:1219 COUNTY LINE ROAD, SUITE C
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-6001
Mailing Address - Country:US
Mailing Address - Phone:614-839-2225
Mailing Address - Fax:614-891-8875
Practice Address - Street 1:1219 COUNTY LINE ROAD, SUITE C
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-6001
Practice Address - Country:US
Practice Address - Phone:614-839-2225
Practice Address - Fax:614-891-8875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2270724Medicaid
OH2270724Medicaid