Provider Demographics
NPI:1073544557
Name:CRESCO CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:CRESCO CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GEHLING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-547-3553
Mailing Address - Street 1:407 7TH STREET SW
Mailing Address - Street 2:
Mailing Address - City:CRESCO
Mailing Address - State:IA
Mailing Address - Zip Code:52136-1805
Mailing Address - Country:US
Mailing Address - Phone:563-547-3553
Mailing Address - Fax:563-547-3552
Practice Address - Street 1:407 7TH STREET SW
Practice Address - Street 2:
Practice Address - City:CRESCO
Practice Address - State:IA
Practice Address - Zip Code:52136-1805
Practice Address - Country:US
Practice Address - Phone:563-547-3553
Practice Address - Fax:563-547-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA12138OtherWELLMARK BCBS