Provider Demographics
NPI:1437308079
Name:WAVERLY CHIROPRACTIC SPECIALTIES
Entity Type:Organization
Organization Name:WAVERLY CHIROPRACTIC SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SCHUTZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:319-352-2425
Mailing Address - Street 1:1240 10TH AVE SW
Mailing Address - Street 2:PO BOX 209
Mailing Address - City:WAVERLY
Mailing Address - State:IA
Mailing Address - Zip Code:50677-0209
Mailing Address - Country:US
Mailing Address - Phone:319-352-2425
Mailing Address - Fax:319-352-4074
Practice Address - Street 1:1240 10TH AVE. SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-0209
Practice Address - Country:US
Practice Address - Phone:319-352-2425
Practice Address - Fax:319-352-4074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty