Provider Demographics
NPI:1225242118
Name:BIG CREEK FAM CHIROPRACTIC PC
Entity Type:Organization
Organization Name:BIG CREEK FAM CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:TULLY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-421-4700
Mailing Address - Street 1:8450 HICKMAN RD STE 7
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-4302
Mailing Address - Country:US
Mailing Address - Phone:515-421-4700
Mailing Address - Fax:515-724-7110
Practice Address - Street 1:8450 HICKMAN RD STE 7
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-4302
Practice Address - Country:US
Practice Address - Phone:515-421-4700
Practice Address - Fax:515-724-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA05181OtherBLUE CROSS BLUE SHIELD
IA0485045Medicaid
IA05181OtherBLUE CROSS BLUE SHIELD