Provider Demographics
NPI:1366647307
Name:SEXTON CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SEXTON CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:SEXTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-287-3993
Mailing Address - Street 1:5921 SE 14TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50320-1746
Mailing Address - Country:US
Mailing Address - Phone:515-287-3993
Mailing Address - Fax:515-287-3044
Practice Address - Street 1:5921 SE 14TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50320-1746
Practice Address - Country:US
Practice Address - Phone:515-287-3993
Practice Address - Fax:515-287-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA24151OtherBC BS
IA0744367Medicaid
IA24151OtherBC BS
IAT71939Medicare UPIN