Provider Demographics
NPI:1114153053
Name:EBERLINE FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:EBERLINE FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:EBERLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DCABN
Authorized Official - Phone:319-824-3650
Mailing Address - Street 1:PO BOX 52
Mailing Address - Street 2:
Mailing Address - City:GRUNDY CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:50638-0052
Mailing Address - Country:US
Mailing Address - Phone:319-824-3650
Mailing Address - Fax:319-824-6780
Practice Address - Street 1:412 G AVE
Practice Address - Street 2:
Practice Address - City:GRUNDY CENTER
Practice Address - State:IA
Practice Address - Zip Code:50638-1747
Practice Address - Country:US
Practice Address - Phone:319-824-3650
Practice Address - Fax:319-824-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06488111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA016655Medicaid
IA16655Medicare PIN