Provider Demographics
NPI:1134300247
Name:FUELLING CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:FUELLING CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:FUELLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-334-3214
Mailing Address - Street 1:231 2ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-1904
Mailing Address - Country:US
Mailing Address - Phone:319-334-3214
Mailing Address - Fax:319-334-2613
Practice Address - Street 1:231 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:IA
Practice Address - Zip Code:50644-1904
Practice Address - Country:US
Practice Address - Phone:319-334-3214
Practice Address - Fax:319-334-2613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1206482Medicaid
IA1206482Medicaid