Provider Demographics
NPI:1497870653
Name:SOUTH DES MOINES CHIROPRACTIC
Entity Type:Organization
Organization Name:SOUTH DES MOINES CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:LYNNAE
Authorized Official - Last Name:NEIL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-244-1823
Mailing Address - Street 1:3300 SW 9TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-7676
Mailing Address - Country:US
Mailing Address - Phone:515-244-1823
Mailing Address - Fax:515-244-4887
Practice Address - Street 1:3300 SW 9TH ST STE 3
Practice Address - Street 2:SUITE 3
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-7666
Practice Address - Country:US
Practice Address - Phone:515-244-1823
Practice Address - Fax:515-244-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05847111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0129692Medicaid
IA19819OtherINS ID
IA0129692Medicaid
IA15017Medicare ID - Type UnspecifiedMEDICARE NUMBER