Provider Demographics
NPI:1366654543
Name:1ST AVENUE CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:1ST AVENUE CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-332-5414
Mailing Address - Street 1:611 1 ST AVE CHIROPRACTIC
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548
Mailing Address - Country:US
Mailing Address - Phone:515-332-5414
Mailing Address - Fax:515-332-5415
Practice Address - Street 1:611 1 ST AVE CHIROPRACTIC
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IA
Practice Address - Zip Code:50548
Practice Address - Country:US
Practice Address - Phone:515-332-5414
Practice Address - Fax:515-332-5415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA5718261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0279810Medicaid
IAI7201Medicare ID - Type Unspecified
IA0279810Medicaid