Provider Demographics
NPI:1386859304
Name:EP TRUE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:EP TRUE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-309-3791
Mailing Address - Street 1:1905 EP TRUE PKWY STE 207
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-7056
Mailing Address - Country:US
Mailing Address - Phone:515-309-3791
Mailing Address - Fax:515-309-3792
Practice Address - Street 1:1905 EP TRUE PKWY STE 207
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-7056
Practice Address - Country:US
Practice Address - Phone:515-309-3791
Practice Address - Fax:515-309-3792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-12
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1220715Medicaid
IA45614OtherBLUE CROSS AND BLUE SHIEL
IA45614OtherBLUE CROSS AND BLUE SHIEL