Provider Demographics
NPI:1225207939
Name:WAUKEE WELLNESS & CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:WAUKEE WELLNESS & CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:NYBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-978-6661
Mailing Address - Street 1:710 ALICES RD
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-9646
Mailing Address - Country:US
Mailing Address - Phone:515-978-6661
Mailing Address - Fax:515-978-6662
Practice Address - Street 1:710 ALICES RD
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-9646
Practice Address - Country:US
Practice Address - Phone:515-978-6661
Practice Address - Fax:515-978-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06841111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty