Provider Demographics
NPI:1447398607
Name:MUSCATINE CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:MUSCATINE CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:ELGATIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-264-8825
Mailing Address - Street 1:2209 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-5258
Mailing Address - Country:US
Mailing Address - Phone:563-264-8825
Mailing Address - Fax:563-264-0869
Practice Address - Street 1:2209 2ND AVE
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5258
Practice Address - Country:US
Practice Address - Phone:563-264-8825
Practice Address - Fax:563-264-0869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1069583Medicaid
IA06744Medicare UPIN
IA1069583Medicaid