Provider Demographics
NPI:1124411483
Name:ELDORA FAMILY CHIROPRACTIC & WELLNESS CENTER PC
Entity Type:Organization
Organization Name:ELDORA FAMILY CHIROPRACTIC & WELLNESS CENTER PC
Other - Org Name:ELDORA CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STOULIL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-368-3790
Mailing Address - Street 1:1376 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ELDORA
Mailing Address - State:IA
Mailing Address - Zip Code:50627-1631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1376 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ELDORA
Practice Address - State:IA
Practice Address - Zip Code:50627-1631
Practice Address - Country:US
Practice Address - Phone:641-939-3831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty