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>> Chiropractor >> Chiropractic Providers

Registrant NPI Number: 1083700579

Individual Registrant:
Gender: M
Sole Proprietor

Location and contact information for practice:
Tel: 712-832-3056  Fax: 712-832-3360

Contact information for business:
PO BOX 246  LAKE PARK, IA 51347-0246 US
Tel: 712-832-3056  Fax: 712-832-3360

Registration Information:
NPI: 1083700579
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y111N00000XChiropractic Providers

Legacy codes, insurance codes and state license numbers:



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