Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | CHIA578 | ID |
NPI | 1083737472 |
---|---|
Provider Name | Irwin Mulnick |
First Address | Mccall, ID 83638-1005 |
Second Address | Mccall, ID 83638-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010019939 | BLUE SHIELD,IRWINMULNICK (01) | ID |
C5782 | BLUE CROSS, IRWIN MULNICK (01) | ID |
T67941 | (02) | ID |