Provider Demographics
NPI:1154325124
Name:BCC INC
Entity Type:Organization
Organization Name:BCC INC
Other - Org Name:BAKERIS FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DC SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAKERIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-545-4444
Mailing Address - Street 1:2411 CORAL COURT
Mailing Address - Street 2:SUITE 3 BAKERIS FAMILY CHIROPRACTIC
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241
Mailing Address - Country:US
Mailing Address - Phone:319-545-4444
Mailing Address - Fax:319-545-4445
Practice Address - Street 1:2411 CORAL COURT
Practice Address - Street 2:SUITE 3
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241
Practice Address - Country:US
Practice Address - Phone:319-545-4444
Practice Address - Fax:319-545-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0295949111N00000X
IA06627111N00000X
IA06624111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0295949Medicaid
IA36601OtherBCBS
IA0295949Medicaid