Provider Demographics
NPI:1164956371
Name:ANTHONY B DEXTER A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ANTHONY B DEXTER A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:B
Authorized Official - Last Name:DEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-396-4697
Mailing Address - Street 1:25139 252ND AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IA
Mailing Address - Zip Code:52768-9721
Mailing Address - Country:US
Mailing Address - Phone:701-570-5648
Mailing Address - Fax:
Practice Address - Street 1:2178 E KIMBERLY RD STE 400
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2230
Practice Address - Country:US
Practice Address - Phone:563-396-4697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-13
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074741111N00000X
ND1043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA074741OtherDC LICENSE