Provider Demographics
NPI:1043410087
Name:EBERT CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:EBERT CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:EBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-232-9436
Mailing Address - Street 1:1445 ANSBOROUGH AVENUE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-3430
Mailing Address - Country:US
Mailing Address - Phone:319-232-9436
Mailing Address - Fax:319-232-2342
Practice Address - Street 1:1445 ANSBOROUGH AVENUE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-3430
Practice Address - Country:US
Practice Address - Phone:319-232-9436
Practice Address - Fax:319-232-2342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04380111N00000X
IA06912111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty