Provider Demographics
NPI:1376936427
Name:FIRM FOUNDATION CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:FIRM FOUNDATION CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-316-0263
Mailing Address - Street 1:974 73RD ST STE 40
Mailing Address - Street 2:
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50324-1026
Mailing Address - Country:US
Mailing Address - Phone:515-440-2005
Mailing Address - Fax:515-440-2039
Practice Address - Street 1:974 73RD ST STE 40
Practice Address - Street 2:
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50324-1026
Practice Address - Country:US
Practice Address - Phone:515-440-2005
Practice Address - Fax:515-440-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007106111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty