Provider Demographics
NPI:1447598719
Name:IDEAL CHIROPRACTIC HEALTH CENTER LLC
Entity Type:Organization
Organization Name:IDEAL CHIROPRACTIC HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EFFERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-512-8862
Mailing Address - Street 1:2200 JFK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2840
Mailing Address - Country:US
Mailing Address - Phone:563-845-7283
Mailing Address - Fax:563-845-7284
Practice Address - Street 1:2200 JFK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-2840
Practice Address - Country:US
Practice Address - Phone:563-845-7283
Practice Address - Fax:563-845-7284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007431305R00000X
IA007413305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization