Provider Demographics
NPI:1235376294
Name:EXPRESSIONS OF LIFE CHIROPRACTIC STUDIO
Entity Type:Organization
Organization Name:EXPRESSIONS OF LIFE CHIROPRACTIC STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:BOSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-340-1504
Mailing Address - Street 1:418 E LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-3044
Mailing Address - Country:US
Mailing Address - Phone:309-786-1700
Mailing Address - Fax:309-786-1700
Practice Address - Street 1:1614 2ND AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-8603
Practice Address - Country:US
Practice Address - Phone:309-786-1700
Practice Address - Fax:309-786-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty