Provider Demographics
NPI:1164529814
Name:MCDONALD CHIROPRACTIC CARE CLINIC
Entity Type:Organization
Organization Name:MCDONALD CHIROPRACTIC CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-338-2273
Mailing Address - Street 1:943 S GILBERT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-4742
Mailing Address - Country:US
Mailing Address - Phone:319-338-2273
Mailing Address - Fax:319-338-1225
Practice Address - Street 1:943 S GILBERT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-4742
Practice Address - Country:US
Practice Address - Phone:319-338-2273
Practice Address - Fax:319-338-1225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04746111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI14723Medicare ID - Type Unspecified