Provider Demographics
NPI:1497951479
Name:SUNNYBROOK CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:SUNNYBROOK CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.C.
Authorized Official - Prefix:DR
Authorized Official - First Name:PAT
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:712-274-1019
Mailing Address - Street 1:5740 SUNNYBROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4249
Mailing Address - Country:US
Mailing Address - Phone:402-494-5173
Mailing Address - Fax:402-494-5151
Practice Address - Street 1:3900 DAKOTA AVE STE 6
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3696
Practice Address - Country:US
Practice Address - Phone:402-494-5173
Practice Address - Fax:402-494-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA=========OtherTAX ID NUMBER