Provider Demographics
NPI:1003987470
Name:CHEBOSKI, MARY M (DC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:M
Last Name:CHEBOSKI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-3129
Mailing Address - Country:US
Mailing Address - Phone:712-792-1763
Mailing Address - Fax:
Practice Address - Street 1:429 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-3129
Practice Address - Country:US
Practice Address - Phone:712-792-1763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05363111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA58787Medicare ID - Type Unspecified