Provider Demographics
NPI:1043768310
Name:UNCOMMON CHIROPRACTIC
Entity Type:Organization
Organization Name:UNCOMMON CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DIRCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-236-7776
Mailing Address - Street 1:2415 18TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3281
Mailing Address - Country:US
Mailing Address - Phone:309-236-7776
Mailing Address - Fax:
Practice Address - Street 1:2415 18TH ST STE 107
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3281
Practice Address - Country:US
Practice Address - Phone:309-236-7776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081460111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty