Provider Demographics
NPI:1114217817
Name:INTRONA CORPORATION
Entity Type:Organization
Organization Name:INTRONA CORPORATION
Other - Org Name:CORALVILLE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:N
Authorized Official - Last Name:INTRONA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-358-8999
Mailing Address - Street 1:850 22ND AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1688
Mailing Address - Country:US
Mailing Address - Phone:319-358-8999
Mailing Address - Fax:319-834-1128
Practice Address - Street 1:850 22ND AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1688
Practice Address - Country:US
Practice Address - Phone:319-358-8999
Practice Address - Fax:319-834-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA06060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA196774Medicaid
IAU-77874Medicare UPIN
IA04079Medicare PIN