Provider Demographics
NPI:1346788643
Name:BELLE PLAINE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:BELLE PLAINE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TAD
Authorized Official - Middle Name:L
Authorized Official - Last Name:JACOBI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-444-2555
Mailing Address - Street 1:732 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:IA
Mailing Address - Zip Code:52208-1753
Mailing Address - Country:US
Mailing Address - Phone:319-444-2555
Mailing Address - Fax:319-444-2555
Practice Address - Street 1:732 12TH ST
Practice Address - Street 2:
Practice Address - City:BELLE PLAINE
Practice Address - State:IA
Practice Address - Zip Code:52208-1753
Practice Address - Country:US
Practice Address - Phone:319-444-2555
Practice Address - Fax:319-444-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty