Provider Demographics
NPI:1093784274
Name:STRUTT CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:STRUTT CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:H
Authorized Official - Last Name:STRUTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-873-3404
Mailing Address - Street 1:333 MAIN STREET
Mailing Address - Street 2:PO BOX C
Mailing Address - City:MC GREGOR
Mailing Address - State:IA
Mailing Address - Zip Code:52157-0503
Mailing Address - Country:US
Mailing Address - Phone:563-873-3404
Mailing Address - Fax:563-873-3405
Practice Address - Street 1:333 MAIN ST
Practice Address - Street 2:
Practice Address - City:MC GREGOR
Practice Address - State:IA
Practice Address - Zip Code:52157-8778
Practice Address - Country:US
Practice Address - Phone:563-873-3404
Practice Address - Fax:563-873-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI7835Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER