Provider Demographics
NPI:1417145616
Name:HELMICH CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:HELMICH CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:HELMICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-362-5236
Mailing Address - Street 1:1820 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-2409
Mailing Address - Country:US
Mailing Address - Phone:712-362-5236
Mailing Address - Fax:712-362-5668
Practice Address - Street 1:1820 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-2409
Practice Address - Country:US
Practice Address - Phone:712-362-5236
Practice Address - Fax:712-362-5668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06685111N00000X
MN3591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN054966500Medicaid
MN054966500Medicaid