Provider Demographics
NPI:1407364532
Name:OMEGA CHIROPRACTIC STUDIO LLC
Entity Type:Organization
Organization Name:OMEGA CHIROPRACTIC STUDIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HARMON
Authorized Official - Last Name:ENSIGN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:563-940-3778
Mailing Address - Street 1:4223 87TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-1401
Mailing Address - Country:US
Mailing Address - Phone:563-940-3778
Mailing Address - Fax:
Practice Address - Street 1:8671 NORTHPARK CT
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2888
Practice Address - Country:US
Practice Address - Phone:563-940-3778
Practice Address - Fax:563-940-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty