Provider Demographics
NPI:1417149493
Name:BELLA VITA CHIROPRACTIC & WELLNESS P.C.
Entity Type:Organization
Organization Name:BELLA VITA CHIROPRACTIC & WELLNESS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DEGRAZIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-887-6992
Mailing Address - Street 1:610 EASTBURY DR.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245
Mailing Address - Country:US
Mailing Address - Phone:319-887-6992
Mailing Address - Fax:319-887-6983
Practice Address - Street 1:610 EASTBURY DR.
Practice Address - Street 2:SUITE 3
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245
Practice Address - Country:US
Practice Address - Phone:319-887-6992
Practice Address - Fax:319-887-6983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA50709OtherWELLMARK PIN
IA50709OtherWELLMARK PIN
IAI6876Medicare PIN