Provider Demographics
NPI:1417175985
Name:LINDBERG CHIROPRACTIC PC
Entity Type:Organization
Organization Name:LINDBERG CHIROPRACTIC PC
Other - Org Name:OTTUMWA CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LINDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:641-682-8301
Mailing Address - Street 1:297 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-4227
Mailing Address - Country:US
Mailing Address - Phone:641-682-8301
Mailing Address - Fax:641-682-8301
Practice Address - Street 1:297 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-4227
Practice Address - Country:US
Practice Address - Phone:641-682-8301
Practice Address - Fax:641-682-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0299404Medicaid
IA0299404Medicaid