Provider Demographics
NPI:1477604502
Name:FAMILY CHIROPRACTIC AND WELLNESS CENTER PC
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC AND WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUSTEDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-446-3613
Mailing Address - Street 1:112 W 2ND ST
Mailing Address - Street 2:PO BOX 423
Mailing Address - City:SUTHERLAND
Mailing Address - State:IA
Mailing Address - Zip Code:51058-0423
Mailing Address - Country:US
Mailing Address - Phone:712-446-3613
Mailing Address - Fax:712-446-2027
Practice Address - Street 1:112 W 2ND ST
Practice Address - Street 2:
Practice Address - City:SUTHERLAND
Practice Address - State:IA
Practice Address - Zip Code:51058-0423
Practice Address - Country:US
Practice Address - Phone:712-446-3613
Practice Address - Fax:712-446-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1290445Medicaid
IA33750OtherBCBS
IAU94777Medicare UPIN
IA33750OtherBCBS