Provider Demographics
NPI:1174853915
Name:REXROTH CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:REXROTH CHIROPRACTIC CENTER
Other - Org Name:REXROTH CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-752-4544
Mailing Address - Street 1:2411 W MOUNT PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-9614
Mailing Address - Country:US
Mailing Address - Phone:319-752-4544
Mailing Address - Fax:319-753-5879
Practice Address - Street 1:2411 W MOUNT PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-9614
Practice Address - Country:US
Practice Address - Phone:319-752-4544
Practice Address - Fax:319-753-5879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04045111N00000X
IA06469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0432146Medicaid
IA0026021Medicaid
IA0026021Medicaid
IA02602Medicare PIN