Provider Demographics
NPI:1053532168
Name:MCIRVIN, MICHAEL D (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:MCIRVIN
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 1:115 E MARLIN ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-4300
Mailing Address - Country:US
Mailing Address - Phone:620-241-8822
Mailing Address - Fax:620-241-8822
Practice Address - Street 1:115 E MARLIN ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-4300
Practice Address - Country:US
Practice Address - Phone:620-241-8822
Practice Address - Fax:620-241-8822
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSC-4003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS023632OtherBCBS MEDICARE PROVIDER NO
KSU-5370Medicare UPIN