Provider Demographics
NPI:1376807339
Name:PUDENZ FAMILY CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:PUDENZ FAMILY CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PUDENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-726-2785
Mailing Address - Street 1:322 W 3RD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-2708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:322 W 3RD ST
Practice Address - Street 2:SUITE B
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2708
Practice Address - Country:US
Practice Address - Phone:563-726-2785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-25
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty