Provider Demographics
NPI:1376716340
Name:CHIROPRACTIC TLC PC
Entity Type:Organization
Organization Name:CHIROPRACTIC TLC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MESCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-665-9066
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-0305
Mailing Address - Country:US
Mailing Address - Phone:319-665-9066
Mailing Address - Fax:
Practice Address - Street 1:1295 JORDAN ST
Practice Address - Street 2:STE. 6
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-8020
Practice Address - Country:US
Practice Address - Phone:319-665-9066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty