Provider Demographics
NPI:1457466328
Name:LABOUNTY FAMILY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:LABOUNTY FAMILY CHIROPRACTIC, INC.
Other - Org Name:BOUNTIFUL LIFE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAMIEN
Authorized Official - Last Name:LABOUNTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-965-8280
Mailing Address - Street 1:1310 SW STATE ST. SUITE B
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-2550
Mailing Address - Country:US
Mailing Address - Phone:515-965-8280
Mailing Address - Fax:515-963-4401
Practice Address - Street 1:1310 SW STATE ST. SUITE B
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-2550
Practice Address - Country:US
Practice Address - Phone:515-965-8280
Practice Address - Fax:515-963-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA118721Medicaid