Provider Demographics
NPI:1275892069
Name:BODY SOLUTIONS CHIROPRACTIC CENTER, INC
Entity Type:Organization
Organization Name:BODY SOLUTIONS CHIROPRACTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEL RAE
Authorized Official - Middle Name:
Authorized Official - Last Name:DERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-370-0656
Mailing Address - Street 1:618 COURT AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IA
Mailing Address - Zip Code:50833-1303
Mailing Address - Country:US
Mailing Address - Phone:712-523-2768
Mailing Address - Fax:712-523-3469
Practice Address - Street 1:618 COURT AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IA
Practice Address - Zip Code:50833-1303
Practice Address - Country:US
Practice Address - Phone:712-523-2768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1124387204Medicaid
IA1275892069Medicaid