Provider Demographics
NPI:1407271208
Name:ROCK VALLEY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:ROCK VALLEY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BROSAMLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-476-2841
Mailing Address - Street 1:1315 GOLF COURSE RD
Mailing Address - Street 2:
Mailing Address - City:ROCK VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51247-1548
Mailing Address - Country:US
Mailing Address - Phone:712-476-2841
Mailing Address - Fax:712-476-5085
Practice Address - Street 1:1315 GOLF COURSE RD
Practice Address - Street 2:
Practice Address - City:ROCK VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51247-1548
Practice Address - Country:US
Practice Address - Phone:712-476-2841
Practice Address - Fax:712-476-5085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty