Provider Demographics
NPI:1477095099
Name:CENTRAL IOWA CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:CENTRAL IOWA CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-597-4022
Mailing Address - Street 1:107 N US HIGHWAY 69
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HUXLEY
Mailing Address - State:IA
Mailing Address - Zip Code:50124-9723
Mailing Address - Country:US
Mailing Address - Phone:515-597-4022
Mailing Address - Fax:515-597-4023
Practice Address - Street 1:107 HWY 69
Practice Address - Street 2:SUITE 2
Practice Address - City:HUXLEY
Practice Address - State:IA
Practice Address - Zip Code:50124-0095
Practice Address - Country:US
Practice Address - Phone:515-597-4022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-14
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081193305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization