Provider Demographics
NPI:1407870025
Name:STICKEL CHIROPRACTIC CLINIC P.C.
Entity Type:Organization
Organization Name:STICKEL CHIROPRACTIC CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLUBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-255-3021
Mailing Address - Street 1:2925 INGERSOLL AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-4014
Mailing Address - Country:US
Mailing Address - Phone:515-255-3021
Mailing Address - Fax:515-274-8732
Practice Address - Street 1:2913 INGERSOLL AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-4014
Practice Address - Country:US
Practice Address - Phone:515-255-3021
Practice Address - Fax:515-274-8732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA53617OtherWELLMARK
IA0139212Medicaid
IAU61337Medicare UPIN
IA0139212Medicaid